Estrogen receptor modulators and uses thereof

ABSTRACT

Described herein are compounds that are estrogen receptor modulators. Also described are pharmaceutical compositions and medicaments that include the compounds described herein, as well as methods of using such estrogen receptor modulators, alone and in combination with other compounds, for treating diseases or conditions that are mediated or dependent upon estrogen receptors.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/963,658, filed 9 Dec. 2015, which is a continuation of InternationalApplication No. PCT/US2014/043040 having an International Filing Date of18 Jun. 2014, and which claims the benefit of priority to U.S.provisional patent application No. 61/836,901, filed on Jun. 19, 2013;and U.S. provisional patent application No. 61/952,430, filed on Mar.13, 2014; all of which are incorporated by reference in their entirety.

FIELD OF THE INVENTION

Described herein are compounds, including pharmaceutically acceptablesalts, solvates, metabolites, prodrugs thereof, methods of making suchcompounds, pharmaceutical compositions comprising such compounds, andmethods of using such compounds to treat, prevent or diagnose diseasesor conditions that are estrogen sensitive, estrogen receptor dependentor estrogen receptor mediated.

BACKGROUND OF THE INVENTION

The estrogen receptor (“ER”) is a ligand-activated transcriptionalregulatory protein that mediates induction of a variety of biologicaleffects through its interaction with endogenous estrogens. Endogenousestrogens include 17β-estradiol and estrones. ER has been found to havetwo isoforms, ER-α and ER-β.

Estrogens and estrogen receptors are implicated in a number of diseasesor conditions, such as breast cancer, lung cancer, ovarian cancer, coloncancer, prostate cancer, endometrial cancer, uterine cancer, as well asothers diseases or conditions.

SUMMARY OF THE INVENTION

In one aspect, presented herein are compounds of Formula (I), (II), and(III), or a pharmaceutically acceptable salt, solvate or prodrugthereof, that diminish the effects of estrogens with estrogen receptorsand/or lower the the concentrations of estrogen receptors, andtherefore, are useful as agents for the treatment or prevention ofdiseases or conditions in which the actions of estrogens and/or estrogenreceptors are involved in the etiology or pathology of the disease orcondition or contribute to at least one symptom of the disease orcondition and wherein such actions of estrogens and/or estrogenreceptors are undesirable. In some embodiments, compounds disclosedherein are estrogen receptor degrader compounds.

In one aspect, compounds of Formula (I), (II), and (III), or apharmaceutically acceptable salt, solvate or prodrug thereof, are usefulfor the treatment of ER-related diseases or conditions including, butnot limited to, ER-α dysfunction associated with cancer (bone cancer,breast cancer, lung cancer, colorectal cancer, endometrial cancer,prostate cancer, ovarian and uterine cancer), central nervous system(CNS) defects (alcoholism, migraine), cardiovascular system defects(aortic aneurysm, susceptibility to myocardial infarction, aortic valvesclerosis, cardiovascular disease, coronary artery disease,hypertension), hematological system defects (deep vein thrombosis),immune and inflammation diseases (Graves' Disease, arthritis, mulitplesclerosis, cirrhosis), susceptibility to infection (hepatitis B, chronicliver disease), metabolic defects (bone density, cholestasis,hypospadias, obesity, osteoarthritis, osteopenia, osteoporosis),neurological defects (Alzheimer's disease, Parkinson's disease,migraine, vertigo), psychiatric defects (anorexia nervosa, attentiondeficity hyperactivity disorder (ADHD), dementia, major depressivedisorder, psychosis), uterine diseases (e.g. leiomyoma, uterineleiomyoma, endometrial hyperplasia, endometriosis), and reproductivedefects (age of menarche, endometriosis, infertility).

In one aspect, described herein are compounds of Formula (I), (II), and(III), pharmaceutically acceptable salts, solvates, metabolites andprodrugs thereof. Compounds described herein are estrogen receptormodulators. In some embodiments, the compound of Formula (I), (II), or(III) is an estrogen receptor antagonist. In some embodiments, thecompound of Formula (I), (II), or (III) is an estrogen receptordegrader. In some embodiments, the compound of Formula (I), (II), or(III) is an estrogen receptor antagonist as well as an estrogen receptordegrader. In some embodiments, the compound of Formula (I), (II), or(III) displays minimal or no estrogen receptor agonist activity. In someembodiments, in the context of treating cancers, the compound of Formula(I), (II), or (III) may offer improved therapeutic activitycharacterized by complete or longer-lasting tumor regression, a lowerincidence or rate of development of resistance to treatment, and/or areduction in tumor invasiveness.

In some embodiments, compounds disclosed herein have high specificityfor the estrogen receptor and have desirable, tissue-selectivepharmacological activities. Desirable, tissue-selective pharmacologicalactivities include, but are not limited to, ER antagonist activity inbreast cells and no ER agonist activity in uterine cells. In someembodiments, compounds disclosed herein are estrogen receptor degradersthat display full estrogen receptor antagonist activity with negligibleor minimal estrogen receptor agonist activity.

In some embodiments, compounds disclosed herein are estrogen receptordegraders. In some embodiments, compounds disclosed herein are estrogenreceptor antagonists. In some embodiments, compounds disclosed hereinhave minimal or negligible estrogen receptor agonist activity.

In some embodiments, presented herein are compounds selected from activemetabolites, tautomers, pharmaceutically acceptable solvates,pharmaceutically acceptable salts or prodrugs of a compound of Formula(I), (II), or (III).

In one aspect, described herein is a compound of Formula (I):

or a pharmaceutically acceptable salt, solvate or prodrug thereof.

In one aspect, described herein is a compound that has the followingstructure of Formula (I):

Also described is a pharmaceutically acceptable salt of a compound thathas the following structure of Formula (I):

In some embodiments, the pharmaceutically acceptable salt of thecompound is an acid addition salt.

In some embodiments, the pharmaceutically acceptable salt of thecompound is a hydrochloric acid salt, a hydrobromic acid salt, asulfuric acid salt, a phosphoric acid salt, a metaphosphoric acid salt,an acetic acid salt, a propionic acid salt, a hexanoic acid salt, acyclopentanepropionic acid salt, a glycolic acid salt, a pyruvic acidsalt, a lactic acid salt, a malonic acid salt, a succinic acid salt, amalic acid salt, a L-malic acid salt, a maleic acid salt, an oxalic acidsalt, a fumaric acid salt, a trifluoroacetic acid salt, a tartaric acidsalt, a L-tartaric acid salt, a citric acid salt, a benzoic acid salt, a3-(4-hydroxybenzoyl)benzoic acid salt, a cinnamic acid salt, a mandelicacid salt, a methanesulfonic acid salt, an ethanesulfonic acid salt, a1,2-ethanedisulfonic acid salt, a 2-hydroxyethanesulfonic acid salt, abenzenesulfonic acid salt, a toluenesulfonic acid salt, a2-naphthalenesulfonic acid salt, a4-methylbicyclo-[2.2.2]oct-2-ene-1-carboxylic acid salt, a glucoheptonicacid salt, a 4,4′-methylenebis-(3-hydroxy-2-ene-1-carboxylic acid) salt,a 3-phenylpropionic acid salt, a trimethylacetic acid salt, a tertiarybutylacetic acid salt, a lauryl sulfuric acid salt, a gluconic acidsalt, a glutamic acid salt, a hydroxynaphthoic acid salt, a salicylicacid salt, a stearic acid salt, a muconic acid salt, a butyric acidsalt, a phenylacetic acid salt, a phenylbutyric acid salt, or a valproicacid salt. In some embodiments, the pharmaceutically acceptable salt ofthe compound is a hydrochloric acid salt. In some embodiments, thepharmaceutically acceptable salt of the compound is formed by reactingthe compound with an inorganic acid. In some embodiments, thepharmaceutically acceptable salt of the compound is formed by reactingthe compound with an inorganic acid, wherein the inorganic acid ishydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, ormetaphosphoric acid. In some embodiments, the pharmaceuticallyacceptable salt of the compound is formed by reacting the compound withan organic acid. In some embodiments, the pharmaceutically acceptablesalt of the compound is formed by reacting the compound with an organicacid, wherein the organic acid is acetic acid, propionic acid, hexanoicacid, cyclopentanepropionic acid, glycolic acid, pyruvic acid, lacticacid, malonic acid, succinic acid, malic acid, L-malic acid, maleicacid, oxalic acid, fumaric acid, trifluoroacetic acid, tartaric acid,L-tartaric acid, citric acid, benzoic acid, 3-(4-hydroxybenzoyl)benzoicacid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfonicacid, 1,2-ethanedisulfonic acid, 2-hydroxyethanesulfonic acid,benzenesulfonic acid, toluenesulfonic acid, 2-naphthalenesulfonic acid,4-methylbicyclo-[2.2.2]oct-2-ene-1-carboxylic acid, glucoheptonic acid,4,4′-methylenebis-(3-hydroxy-2-ene-1-carboxylic acid), 3-phenylpropionicacid, trimethylacetic acid, tertiary butylacetic acid, lauryl sulfuricacid, gluconic acid, glutamic acid, hydroxynaphthoic acid, salicylicacid, stearic acid, muconic acid, butyric acid, phenylacetic acid,phenylbutyric acid, or valproic acid. In some embodiments, describedherein is a hydrochloride salt of a compound that has the structure ofFormula (I).

Also described herein is a prodrug of a compound that has the followingstructure of Formula (I):

Also described herein is a pharmaceutically acceptable salt of a prodrugof a compound that has the following structure of Formula (I):

In some embodiments, the pharmaceutically acceptable salt of the prodrugof a compound of Formula (I) is a hydrochloride salt.

In some embodiments, described is a pharmaceutical compositioncomprising a compound or a pharmaceutically acceptable salt or prodrugof a compound of Formula (I). In some embodiments, the pharmaceuticalcomposition is formulated for intravenous injection, subcutaneousinjection, oral administration, or topical administration. In someembodiments, the pharmaceutical composition is a tablet, a pill, acapsule, a liquid, a suspension, a gel, a dispersion, a solution, anemulsion, an ointment, or a lotion.

Also described herein is a compound that has the following structure ofFormula (II):

or a pharmaceutically acceptable salt, solvate or prodrug thereof.

In one aspect, described herein is a compound that has the followingstructure of Formula (II):

In another aspect, described herein is a pharmaceutically acceptablesalt of a compound that has the following structure of Formula (II):

In some embodiments, the pharmaceutically acceptable salt of thecompound is an acid addition salt. In some embodiments, thepharmaceutically acceptable salt of the compound is a hydrochloric acidsalt, a hydrobromic acid salt, a sulfuric acid salt, a phosphoric acidsalt, a metaphosphoric acid salt, an acetic acid salt, a propionic acidsalt, a hexanoic acid salt, a cyclopentanepropionic acid salt, aglycolic acid salt, a pyruvic acid salt, a lactic acid salt, a malonicacid salt, a succinic acid salt, a malic acid salt, a L-malic acid salt,a maleic acid salt, an oxalic acid salt, a fumaric acid salt, atrifluoroacetic acid salt, a tartaric acid salt, a L-tartaric acid salt,a citric acid salt, a benzoic acid salt, a 3-(4-hydroxybenzoyl)benzoicacid salt, a cinnamic acid salt, a mandelic acid salt, a methanesulfonicacid salt, an ethanesulfonic acid salt, a 1,2-ethanedisulfonic acidsalt, a 2-hydroxyethanesulfonic acid salt, a benzenesulfonic acid salt,a toluenesulfonic acid salt, a 2-naphthalenesulfonic acid salt, a4-methylbicyclo-[2.2.2]oct-2-ene-1-carboxylic acid salt, a glucoheptonicacid salt, a 4,4′-methylenebis-(3-hydroxy-2-ene-1-carboxylic acid) salt,a 3-phenylpropionic acid salt, a trimethylacetic acid salt, a tertiarybutylacetic acid salt, a lauryl sulfuric acid salt, a gluconic acidsalt, a glutamic acid salt, a hydroxynaphthoic acid salt, a salicylicacid salt, a stearic acid salt, a muconic acid salt, a butyric acidsalt, a phenylacetic acid salt, a phenylbutyric acid salt, or a valproicacid salt. In some embodiments, the pharmaceutically acceptable salt ofthe compound is a hydrochloric acid salt. In some embodiments, thepharmaceutically acceptable salt of the compound is formed by reactingthe compound with an inorganic acid. In some embodiments, thepharmaceutically acceptable salt of the compound is formed by reactingthe compound with an inorganic acid, wherein the inorganic acid ishydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, ormetaphosphoric acid. In some embodiments, the pharmaceuticallyacceptable salt of the compound is formed by reacting the compound withan organic acid. In some embodiments, the pharmaceutically acceptablesalt of the compound is formed by reacting the compound with an organicacid, wherein the organic acid is acetic acid, propionic acid, hexanoicacid, cyclopentanepropionic acid, glycolic acid, pyruvic acid, lacticacid, malonic acid, succinic acid, malic acid, L-malic acid, maleicacid, oxalic acid, fumaric acid, trifluoroacetic acid, tartaric acid,L-tartaric acid, citric acid, benzoic acid, 3-(4-hydroxybenzoyl)benzoicacid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfonicacid, 1,2-ethanedisulfonic acid, 2-hydroxyethanesulfonic acid,benzenesulfonic acid, toluenesulfonic acid, 2-naphthalenesulfonic acid,4-methylbicyclo-[2.2.2]oct-2-ene-1-carboxylic acid, glucoheptonic acid,4,4′-methylenebis-(3-hydroxy-2-ene-1-carboxylic acid), 3-phenylpropionicacid, trimethylacetic acid, tertiary butylacetic acid, lauryl sulfuricacid, gluconic acid, glutamic acid, hydroxynaphthoic acid, salicylicacid, stearic acid, muconic acid, butyric acid, phenylacetic acid,phenylbutyric acid, or valproic acid. In some embodiments, describedherein is a hydrochloride salt of a compound that has the structure ofFormula (II).

In another aspect, described herein is a prodrug of a compound that hasthe following structure of Formula (II):

In another aspect, described herein is a pharmaceutically acceptablesalt of a prodrug of a compound that has the following structure ofFormula (II):

In some embodiments, the pharmaceutically acceptable salt of the prodrugof a compound of Formula (II) is a hydrochloride salt.

In some embodiments, described herein is a pharmaceutical compositioncomprising a compound or a pharmaceutically acceptable salt or prodrugof a compound of Formula (II). In some embodiments, the pharmaceuticalcomposition is formulated for intravenous injection, subcutaneousinjection, oral administration, or topical administration. In someembodiments, the pharmaceutical composition is a tablet, a pill, acapsule, a liquid, a suspension, a gel, a dispersion, a solution, anemulsion, an ointment, or a lotion. In some embodiments, theenantiomeric ratio of the compound is greater than 90:10. In someembodiments, the enantiomeric ratio of the compound is greater than95:5. In some embodiments, the enantiomeric ratio of the compound isgreater than 99:1.

In another aspect, described herein is a compound that has the followingstructure of Formula (III):

or a pharmaceutically acceptable salt, solvate or prodrug thereof.

In one aspect, described herein is a compound that has the followingstructure of Formula (III):

In another aspect, described herein is a pharmaceutically acceptablesalt of a compound that has the following structure of Formula (III):

In some embodiments, the pharmaceutically acceptable salt of thecompound is an acid addition salt. In some embodiments, thepharmaceutically acceptable salt of the compound is a hydrochloric acidsalt, a hydrobromic acid salt, a sulfuric acid salt, a phosphoric acidsalt, a metaphosphoric acid salt, an acetic acid salt, a propionic acidsalt, a hexanoic acid salt, a cyclopentanepropionic acid salt, aglycolic acid salt, a pyruvic acid salt, a lactic acid salt, a malonicacid salt, a succinic acid salt, a malic acid salt, a L-malic acid salt,a maleic acid salt, an oxalic acid salt, a fumaric acid salt, atrifluoroacetic acid salt, a tartaric acid salt, a L-tartaric acid salt,a citric acid salt, a benzoic acid salt, a 3-(4-hydroxybenzoyl)benzoicacid salt, a cinnamic acid salt, a mandelic acid salt, a methanesulfonicacid salt, an ethanesulfonic acid salt, a 1,2-ethanedisulfonic acidsalt, a 2-hydroxyethanesulfonic acid salt, a benzenesulfonic acid salt,a toluenesulfonic acid salt, a 2-naphthalenesulfonic acid salt, a4-methylbicyclo-[2.2.2]oct-2-ene-1-carboxylic acid salt, a glucoheptonicacid salt, a 4,4′-methylenebis-(3-hydroxy-2-ene-1-carboxylic acid) salt,a 3-phenylpropionic acid salt, a trimethylacetic acid salt, a tertiarybutylacetic acid salt, a lauryl sulfuric acid salt, a gluconic acidsalt, a glutamic acid salt, a hydroxynaphthoic acid salt, a salicylicacid salt, a stearic acid salt, a muconic acid salt, a butyric acidsalt, a phenylacetic acid salt, a phenylbutyric acid salt, or a valproicacid salt. In some embodiments, the pharmaceutically acceptable salt ofthe compound is a hydrochloric acid salt. In some embodiments, thepharmaceutically acceptable salt of the compound is formed by reactingthe compound with an inorganic acid. In some embodiments, thepharmaceutically acceptable salt of the compound is formed by reactingthe compound with an inorganic acid, wherein the inorganic acid ishydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, ormetaphosphoric acid. In some embodiments, the pharmaceuticallyacceptable salt of the compound is formed by reacting the compound withan organic acid. In some embodiments, the pharmaceutically acceptablesalt of the compound is formed by reacting the compound with an organicacid, wherein the organic acid is acetic acid, propionic acid, hexanoicacid, cyclopentanepropionic acid, glycolic acid, pyruvic acid, lacticacid, malonic acid, succinic acid, malic acid, L-malic acid, maleicacid, oxalic acid, fumaric acid, trifluoroacetic acid, tartaric acid,L-tartaric acid, citric acid, benzoic acid, 3-(4-hydroxybenzoyl)benzoicacid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfonicacid, 1,2-ethanedisulfonic acid, 2-hydroxyethanesulfonic acid,benzenesulfonic acid, toluenesulfonic acid, 2-naphthalenesulfonic acid,4-methylbicyclo-[2.2.2]oct-2-ene-1-carboxylic acid, glucoheptonic acid,4,4′-methylenebis-(3-hydroxy-2-ene-1-carboxylic acid), 3-phenylpropionicacid, trimethylacetic acid, tertiary butylacetic acid, lauryl sulfuricacid, gluconic acid, glutamic acid, hydroxynaphthoic acid, salicylicacid, stearic acid, muconic acid, butyric acid, phenylacetic acid,phenylbutyric acid, or valproic acid. In some embodiments, describedherein is a hydrochloride salt of a compound that has the structure ofFormula (III).

Also described herein is a prodrug of a compound that has the followingstructure of Formula (III):

Also described herein is a pharmaceutically acceptable salt of a prodrugof a compound that has the following structure of Formula (III):

In some embodiments, the pharmaceutically acceptable salt of the prodrugof a compound of Formula (III) is a hydrochloride salt.

In some embodiments, described herein is a pharmaceutical compositioncomprising a compound or a pharmaceutically acceptable salt or prodrugof a compound of Formula (III). In some embodiments, the pharmaceuticalcomposition is formulated for intravenous injection, subcutaneousinjection, oral administration, or topical administration. In someembodiments, the pharmaceutical composition is a tablet, a pill, acapsule, a liquid, a suspension, a gel, a dispersion, a solution, anemulsion, an ointment, or a lotion. In some embodiments, theenantiomeric ratio of the compound is greater than 90:10. In someembodiments, the enantiomeric ratio of the compound is greater than95:5. In some embodiments, the enantiomeric ratio of the compound isgreater than 99:1.

In some embodiments, the pharmaceutical composition described hereinfurther comprises, in addition to the compound of Formula (I), (II), or(III), one or more additional therapeutically active agents selectedfrom: corticosteroids, anti-emetic agents, analgesics, anti-canceragents, anti-inflammatories, kinase inhibitors, antibodies, HSP90inhibitors, histone deacetylase (HDAC) inhibitors, poly ADP-ribosepolymerase (PARP) inhibitors, and aromatase inhibitors.

In some embodiments, provided herein is a method comprisingadministering a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt or prodrug thereof, to a human with adiseases or condition that is estrogen sensitive, estrogen receptormeditated or estrogen receptor dependent. In some embodiments, the humanis already being administered one or more additional therapeuticallyactive agents other than a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt or prodrug thereof. In someembodiments, the method further comprises administering one or moreadditional therapeutically active agents other than a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable salt orprodrug thereof.

In some embodiments, the one or more additional therapeutically activeagents other than a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt or prodrug thereof, are selected from:corticosteroids, anti-emetic agents, analgesics, anti-cancer agents,anti-inflammatories, kinase inhibitors, antibodies, HSP90 inhibitors,histone deacetylase (HDAC) inhibitors, and aromatase inhibitors.

Pharmaceutical formulations described herein are administered to amammal in a variety of ways, including but not limited to, oral,parenteral (e.g., intravenous, subcutaneous, intramuscular), buccal,topical or transdermal administration routes. The pharmaceuticalformulations described herein include, but are not limited to, aqueousliquid dispersions, self-emulsifying dispersions, solid solutions,liposomal dispersions, solid dosage forms, powders, immediate releaseformulations, controlled release formulations, fast melt formulations,tablets, capsules, pills, delayed release formulations, extended releaseformulations, pulsatile release formulations, multiparticulateformulations, and mixed immediate and controlled release formulations.

In some embodiments, the compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt or prodrug thereof, is administeredorally.

In some embodiments, the compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt or prodrug thereof, is administeredsystemically.

In some embodiments, the compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt or prodrug thereof, is administeredintravenously.

In some embodiments, the compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt or prodrug thereof, is administeredsubcutaneously.

In some embodiments, the compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt or prodrug thereof, is administeredtopically. In such embodiments, the compound of Formula (I), (II), or(III), or a pharmaceutically acceptable salt or prodrug thereof, isformulated into a variety of topically administrable compositions, suchas solutions, suspensions, lotions, gels, pastes, shampoos, scrubs,rubs, smears, medicated sticks, medicated bandages, balms, creams orointments. In some embodiments, the compound of Formula (I), (II), or(III), or a pharmaceutically acceptable salt or prodrug thereof, isadministered topically to the skin of mammal.

In another aspect is the use of a compound of Formula (I), (II), or(III), or a pharmaceutically acceptable salt or prodrug thereof, in themanufacture of a medicament for treating a disease, disorder orconditions in which the activity of estrogen receptors contributes tothe pathology and/or symptoms of the disease or condition. In oneaspect, the disease or condition is any of the diseases or conditionsspecified herein.

In any of the aforementioned aspects are further embodiments in whichthe effective amount of the compound of Formula (I), (II), or (III), ora pharmaceutically acceptable salt thereof, is: (a) systemicallyadministered to the mammal; and/or (b) administered orally to themammal; and/or (c) intravenously administered to the mammal; and/or (d)administered by injection to the mammal; and/or (e) administeredtopically to the mammal; and/or (f) adminstered non-systemically orlocally to the mammal.

In any of the aforementioned aspects are further embodiments comprisingsingle administrations of the effective amount of the compound,including further embodiments in which (i) the compound is administeredonce; (ii) the compound is administered to the mammal multiple timesover the span of one day; (iii) continually; or (iv) continuously.

In any of the aforementioned aspects are further embodiments comprisingmultiple administrations of the effective amount of the compound,including further embodiments in which (i) the compound is administeredcontinuously or intermittently: as in a a single dose; (ii) the timebetween multiple administrations is every 6 hours; (iii) the compound isadministered to the mammal every 8 hours; (iv) the compound isadministered to the mammal every 12 hours; (v) the compound isadministered to the mammal every 24 hours. In further or alternativeembodiments, the method comprises a drug holiday, wherein theadministration of the compound is temporarily suspended or the dose ofthe compound being administered is temporarily reduced; at the end ofthe drug holiday, dosing of the compound is resumed. In one embodiment,the length of the drug holiday varies from 2 days to 1 year.

Also provided is a method of reducing ER activation in a mammalcomprising administering to the mammal at least one compound having thestructure of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof. In some embodiments, the method comprisesreducing ER activation in breast cells, lung cells, ovarian cells, coloncells, prostate cells, endometrial cells, or uterine cells in themammal. In some embodiments, the method comprises reducing ER activationin breast cells, ovarian cells, colon cells, prostate cells, endometrialcells, or uterine cells in the mammal. In some embodiments, the methodof reducing ER activation in the mammal comprises reducing the bindingof estrogens to estrogen receptors in the mammal. In some embodiments,the method of reducing ER activation in the mammal comprises reducing ERconcentrations in the mammal.

In one aspect is the use of a compound of Formula (I), (II), or (III),or a pharmaceutically acceptable salt thereof, in the treatment orprevention of diseases or conditions of the uterus in a mammal. In someembodiments, the disease or condition of the uterus is leiomyoma,uterine leiomyoma, endometrial hyperplasia, or endometriosis. In someembodiments, the disease or condition of the uterus is a cancerousdisease or condition of the uterus. In some other embodiments, thedisease or condition of the uterus is a non-cancerous disease orcondition of the uterus.

In one aspect is the use of a compound of Formula (I), (II), or (III),or a pharmaceutically acceptable salt thereof, in the manufacture of amedicament for the treatment of diseases or conditions that are estrogensensitive, estrogen receptor dependent or estrogen receptor mediated. Insome embodiments, the disease or condition is breast cancer, lungcancer, ovarian cancer, colon cancer, prostate cancer, endometrialcancer, or uterine cancer. In some embodiments, the disease or conditionis described herein.

In some cases disclosed herein is the use of a compound of Formula (I),(II), or (III), or a pharmaceutically acceptable salt thereof, in thetreatment or prevention of diseases or conditions that are estrogensensitive, estrogen receptor dependent or estrogen receptor mediated. Insome embodiments, the disease or condition is described herein.

In any of the embodiments disclosed herein, the mammal is a human.

In some embodiments, compounds provided herein are used to diminish,reduce, or eliminate the activity of estrogen receptors.

Articles of manufacture, which include: packaging material; a compoundof Formula (I), (II), or (III), or a pharmaceutically acceptable salt,active metabolite, prodrug, or pharmaceutically acceptable solvatethereof, or composition thereof, within the packaging material; and alabel that indicates that the compound or pharmaceutically acceptablesalt, active metabolite, prodrug, or pharmaceutically acceptable solvatethereof, or composition thereof, or composition thereof, is used forreducing, diminishing or eliminating the effects of estrogen receptors,or for the treatment, prevention or amelioration of one or more symptomsof a disease or condition that would benefit from a reduction orelimination of estrogen receptor activity, are provided.

Other objects, features and advantages of the compounds, methods andcompositions described herein will become apparent from the followingdetailed description. It should be understood, however, that thedetailed description and the specific examples, while indicatingspecific embodiments, are given by way of illustration only, sincevarious changes and modifications within the spirit and scope of theinstant disclosure will become apparent to those skilled in the art fromthis detailed description

DETAILED DESCRIPTION OF THE INVENTION

Estrogen receptor alpha (ER-α; NR3A1) and estrogen receptor beta (ER-β;NR3A2) are steroid hormone receptors, which are members of the largenuclear receptor superfamily. Nuclear receptors share a common modularstructure, which minimally includes a DNA binding domain (DBD) and aligand binding domain (LBD). Steroid hormone receptors are soluble,intracellular proteins that act as ligand-regulated transcriptionfactors. Vertebrates contain five closely related steroid hormonereceptors (estrogen receptor, androgen receptor, progesterone receptor,glucocorticoid receptor, mineralcorticoid receptor), which regulate awide spectrum of reproductive, metabolic and developmental activities.The activities of ER are controlled by the binding of endogenousestrogens, including 17β-estradiol and estrones.

The ER-α gene is located on 6q25.1 and encodes a 595 AA protein. TheER-β gene resides on chromosome 14q23.3 and produces a 530 AA protein.However, due to alternative splicing and translation start sites, eachof these genes can give rise to multiple isoforms. In addition to theDNA binding domain (called C domain) and ligand binding domain (Edomain) these receptors contain an N-terminal (A/B) domain, a hinge (D)domain that links the C and E domains, and a C-terminal extension (Fdomain) (Gronemeyer and Laudet; Protein Profile 2: 1173-1308, 1995).While the C and E domains of ER-α and ER-β are quite conserved (95% and55% amino acid identity, respectively), conservation of the A/B, D and Fdomains is poor (below 30% amino acid identity). Both receptors areinvolved in the regulation and development of the female reproductivetract but also play various roles in the central nervous system,cardiovascular systems and bone metabolism.

The ligand binding pocket of steroid hormone receptors is deeply buriedwithin the ligand binding domain. Upon binding, the ligand becomes partof the hydrophobic core of this domain. Consequently most steroidhormone receptors are instable in the absence of hormone and requireassistance from chaperones, such as Hsp90, in order to maintainhormone-binding competency. The interaction with Hsp90 also controlsnuclear translocation of these receptors. Ligand-binding stabilizes thereceptor and initiates sequential conformational changes that releasethe chaperones, alter the interactions between the various receptordomains and remodel protein interaction surfaces that allow thesereceptors to translocate into the nucleus, bind DNA and engage ininteractions with chromatin remodeling complexes and the transcriptionalmachinery. Although ER can interact with Hsp90, this interaction is notrequired for hormone binding and, dependent on the cellular context,apo-ER can be both cytoplasmic and nuclear. Biophysical studiesindicated that DNA binding rather than ligand binding contributes to thestability of the receptor (Greenfield et al., Biochemistry 40:6646-6652, 2001).

ER can interact with DNA either directly by binding to a specific DNAsequence motif called estrogen response element (ERE) (classicalpathway), or indirectly via protein-protein interactions (nonclassicalpathway) (Welboren et al., Endocrine-Related Cancer 16: 1073-1089,2009). In the nonclassical pathway, ER has been shown to tether to othertranscription factors including SP-1, AP-1 and NF-κB. These interactionsappear to play critical roles in the ability of ER to regulate cellproliferation and differentiation.

Both types of ER DNA interactions can result in gene activation orrepression dependent on the transcriptional coregulators that arerecruited by the respective ER-ERE complex (Klinge, Steroid 65: 227-251,2000). The recruitment of coregulators is primarily mediated by twoprotein interaction surfaces, the AF2 and AF1. AF2 is located in the ERE-domain and its conformation is directly regulated by the ligand(Brzozowski et al., Nature 389: 753-758, 1997). Full agonists appear topromote the recruitment of co-activators, whereas weak agonists andantagonists facilitate the binding of co-repressors. The regulation ofprotein with the AF1 is less well understood but can be controlled byserine phosphorylation (Ward and Weigel, Biofactors 35: 528-536, 2009).One of the involved phosphorylation sites (S118) appears to control thetranscriptional activity of ER in the presence of antagonists such astamoxifen, which plays an important role in the treatment of breastcancer. While full agonists appear to arrest ER in certain conformation,weak agonists tend to maintain ER in equilibrium between differentconformations, allowing cell-dependent differences in co-regulatorrepertoires to modulate the activity of ER in a cell-dependent manner(Tamrazi et al., Mol. Endocrinol. 17: 2593-2602, 2003). Interactions ofER with DNA are dynamic and include, but are not limited to, thedegradation of ER by the proteasome (Reid et al., Mol Cell 11: 695-707,2003). The degradation of ER with ligands provides an attractivetreatment strategy for diseases or conditions that areestrogen-senstitive and/or resistant to available anti-hormonaltreatments.

ER signaling is crucial for the development and maintenance of femalereproductive organs including breasts, ovulation and thickening of theendometrium. ER signaling also has a role in bone mass, lipidmetabolism, cancers, etc. About 70% of breast cancers express ER-α (ER-αpositive) and are dependent on estrogens for growth and survival. Othercancers also are thought to be dependent on ER-α signaling for growthand survival, such as for example ovarian and endometrial cancers. TheER-α antagonist tamoxifen has been used to treat early and advanced ER-αpositive breast cancer in both pre- and post-menopausal women.Fulvestrant (Faslodex™) a steroid-based ER antagonist is used to treatbreast cancer in women which have progressed despite therapy withtamoxifen. Steroidal and non-steroidal aromatase inhibitors are alsoused to treat cancers in humans. In some embodiments, the steroidal andnon-steroidal aromatase inhibitors block the production of estrogen fromandrostenedione and testosterone in post-menopausal women, therebyblocking ER dependent growth in the cancers. In addition to theseanti-hormonal agents, progressive ER positive breast cancer is treatedin some cases with a variety of other chemotherapeutics, such as forexample, the anthracylines, platins, taxanes. In some cases, ER positivebreast cancers that harbor genetic amplication of the ERB-B/HER2tyrosine kinase receptor are treated with the monoclonal antibodytrastuzumab (Herceptin™) or the small molecule pan-ERB-B inhibitorlapatinib. Despite this battery of anti-hormonal, chemotherapeutic andsmall-molecule and antibody-based targeted therapies, many women withER-α positive breast develop progressive metastatic disease and are inneed of new therapies. Importantly, the majority of ER positive tumorsthat progress on existing anti-hormonal, as well as and other therapies,are thought to remain dependent on ER-α for growth and survival. Thus,there is a need for new ER-α targeting agents that have activity in thesetting of metastatic disease and acquired resistance. In one aspect,described herein are compounds that are selective estrogen receptormodulators (SERMs). In specific embodiments, the SERMs described hereinare selective estrogen receptor degraders (SERDs). In some embodiments,in cell-based assays the compounds described herein result in areduction in steady state ER-α levels (i.e. ER degradation) and areuseful in the treatment of estrogen sensitive diseases or conditionsand/or diseases or conditions that have developed resistant toanti-hormonal therapies.

Given the central role of ER-α in breast cancer development andprogression, compounds disclosed herein are useful in the treatment ofbreast cancer, either alone or in combination with other agent agentsthat can modulate other critical pathways in breast cancer, includingbut not limited to those that target IGF1R, EGFR, erB-B2 and 3 thePI3K/AKT/mTOR axis, HSP90, PARP or histone deacetylases.

Given the central role of ER-α in breast cancer development andprogression, compounds disclosed herein are useful in the treatment ofbreast cancer, either alone or in combination with other agent used totreat breast cancer, including but not limited to aromatase inhibitors,anthracylines, platins, nitrogen mustard alkylating agents, taxanes.Illustrative agent used to treat breast cancer, include, but are notlimited to, paclitaxel, anastrozole, exemestane, cyclophosphamide,epirubicin, fulvestrant, letrozole, gemcitabine, trastuzumab,pegfilgrastim, filgrastim, tamoxifen, docetaxel, toremifene,vinorelbine, capecitabine, ixabepilone, as well as others describedherein.

ER-related diseases or conditions include ER-α dysfunction is associatedwith cancer (bone cancer, breast cancer, lung cancer, colorectal cancer,endometrial cancer, prostate cancer, ovarian and uterine cancer),central nervous system (CNS) defects (alcoholism, migraine),cardiovascular system defects (aortic aneurysm, susceptibility tomyocardial infarction, aortic valve sclerosis, cardiovascular disease,coronary artery disease, hypertension), hematological system defects(deep vein thrombosis), immune and inflammation diseases (Graves'Disease, arthritis, mulitple sclerosis, cirrhosis), susceptibility toinfection (hepatitis B, chronic liver disease), metabolic defects (bonedensity, cholestasis, hypospadias, obesity, osteoarthritis, osteopenia,osteoporosis), neurological defects (Alzheimer's disease, Parkinson'sdisease, migraine, vertigo), psychiatric defects (anorexia nervosa,attention deficity hyperactivity disorder (ADHD), dementia, majordepressive disorder, psychosis) and reproductive defects (age ofmenarche, endometriosis, infertility.

In some embodiments, compounds disclosed herein are used in thetreatment of an estrogen receptor dependent or estrogen receptormediated disease or condition in mammal.

In some embodiments, the estrogen receptor dependent or estrogenreceptor mediated disease or condition is selected from cancer, centralnervous system (CNS) defects, cardiovascular system defects,hematological system defects, immune and inflammation diseases,susceptibility to infection, metabolic defects, neurological defects,psychiatric defects and reproductive defects.

In some embodiments, the estrogen receptor dependent or estrogenreceptor mediated disease or condition is selected from bone cancer,breast cancer, lung cancer, colorectal cancer, endometrial cancer,prostate cancer, ovarian cancer, uterine cancer, alcoholism, migraine,aortic aneurysm, susceptibility to myocardial infarction, aortic valvesclerosis, cardiovascular disease, coronary artery disease,hypertension, deep vein thrombosis, Graves' Disease, arthritis, multiplesclerosis, cirrhosis, hepatitis B, chronic liver disease, bone density,cholestasis, hypospadias, obesity, osteoarthritis, osteopenia,osteoporosis, Alzheimer's disease, Parkinson's disease, migraine,vertigo, anorexia nervosa, attention deficity hyperactivity disorder(ADHD), dementia, major depressive disorder, psychosis, age of menarche,endometriosis, and infertility.

In some embodiments, compounds disclosed herein are used to treat cancerin a mammal. In some embodiments, the cancer is breast cancer, ovariancancer, endometrial cancer, prostate cancer, or uterine cancer. In someembodiments, the cancer is breast cancer, lung cancer, ovarian cancer,endometrial cancer, prostate cancer, or uterine cancer. In someembodiments, the cancer is breast cancer. In some embodiments, thecancer is a hormone dependent cancer. In some embodiments, the cancer isan estrogen receptor dependent cancer. In some embodiments, the canceris an estrogen-sensitive cancer. In some embodiments, the cancer isresistant to anti-hormonal treatment. In some embodiments, the cancer isan estrogen-sensitive cancer or an estrogen receptor dependent cancerthat is resistant to anti-hormonal treatment. In some embodiments, thecancer is a hormone-sensitive cancer or a hormone receptor dependentcancer that is resistant to anti-hormonal treatment. In someembodiments, anti-hormonal treatment includes treatment with at leastone agent selected from tamoxifen, fulvestrant, steroidal aromataseinhibitors, and non-steroidal aromatase inhibitors.

In some embodiments, compounds disclosed herein are used to treathormone receptor positive metastatic breast cancer in a postmenopausalwoman with disease progression following anti-estrogen therapy.

In some embodiments, compounds disclosed herein are used to treat ahormonal dependent benign or malignant disease of the breast orreproductive tract in a mammal. In some embodiments, the benign ormalignant disease is breast cancer.

In some embodiments, the compound used in any of the methods describedherein is an estrogen receptor degrader; is an estrogen receptorantagonist; has minimal or negligible estrogen receptor agonistactivity; or combinations thereof.

In some embodiments, methods of treatment with compounds describedherein include a treatment regimen that includes administering radiationtherapy to the mammal.

In some embodiments, methods of treatment with compounds describedherein include administering the compound prior to or following surgery.

In some embodiments, methods of treatment with compounds describedherein include administering to the mammal at least one additionalanti-cancer agent.

In some embodiments, compounds disclosed herein are used to treat cancerin a mammal, wherein the mammal is chemotherapy-naïve.

In some embodiments, compounds disclosed herein are used in thetreatment of cancer in a mammal. In some embodiments, compoundsdisclosed herein are used to treat cancer in a mammal, wherein themammal is being treated for cancer with at least one anti-cancer agent.In one embodiment, the cancer is a hormone refractory cancer.

In some embodiments, compounds disclosed herein are used in thetreatment or prevention of diseases or conditions of the uterus in amammal. In some embodiments, the disease or condition of the uterus isleiomyoma, uterine leiomyoma, endometrial hyperplasia, or endometriosis.In some embodiments, the disease or condition of the uterus is acancerous disease or condition of the uterus. In some other embodiments,the disease or condition of the uterus is a non-cancerous disease orcondition of the uterus.

In some embodiments, compounds disclosed herein are used in thetreatment of endometriosis in a mammal.

In some embodiments, compounds disclosed herein are used in thetreatment of leiomyoma in a mammal. In some embodiments, the leiomyomais a uterine leiomyoma, esophageal leiomyoma, cutaneous leiomyoma, orsmall bowel leiomyoma. In some embodiments, compounds disclosed hereinare used in the treatment of fibroids in a mammal. In some embodiments,compounds disclosed herein are used in the treatment of uterine fibroidsin a mammal.

Compound of Formula (I), (II), or (III)

The Compound of Formula (I), (II), or (III), including pharmaceuticallyacceptable salts, prodrugs, active metabolites and pharmaceuticallyacceptable solvates thereof, is an estrogen receptor modulator. Inspecific embodiments, the compound is estrogen receptor degrader. Inspecific embodiments, the compound is an estrogen receptor antagonist.In specific embodiments, the compound is an estrogen receptor degraderand estrogen receptor antagonist with minimal or no estrogen receptoragonist activity.

In some embodiments, compounds disclosed herein are estrogen receptordegraders and estrogen receptor antagonists that exhibit: minimal or noestrogen receptor agonism; and/or anti-proliferative activity againstbreast cancer, ovarian cancer, endometrial cancer, cervical cancer celllines; and/or maximal anti-proliferative efficacy against breast cancer,ovarian cancer, endometrial cancer, cervical cell lines in-vitro; and/orminimal agonism in the human endometrial (Ishikawa) cell line; and/orminimal or no agonism in the human endometrial (Ishikawa) cell line;and/or minimal or no agonism in the immature rat uterine assay in-vivo;and/or inverse agonism in the immature rat uterine assay in-vivo; and/oranti-tumor activity in breast cancer, ovarian cancer, endometrialcancer, cervical cancer cell lines in xenograft assays in-vivo or otherrodent models of these cancers.

In some embodiments, compounds described herein have reduced or minimalinteraction with the hERG (the human Ether-à-go-go-Related Gene) channeland/or show a reduced potential for QT prolongation and/or a reducedrisk of ventricular tachyarrhythmias like torsades de pointes.

In some embodiments, the compound of Formula (I), (II), or (III), hasreduced or minimal potential to access the hypothalamus and/or havereduced or minimal potential to modulate theHypothalamic-Pituitary-Ovarian (HPO) axis and/or show a reducedpotential to cause hyper-stimulation of the ovaries and/or show areduced potential for ovary toxicity.

In some embodiments, the compound of Formula (I), (II), or (III), foruse in the treatment of a disease or condition in a pre-menopausal womanhave reduced or minimal potential to access the hypothalamus and/or havereduced or minimal potential to modulate theHypothalamic-Pituitary-Ovarian (HPO) axis and/or show a reducedpotential to cause hyper-stimulation of the ovaries and/or show areduced potential for ovary toxicity. In some embodiments, the diseaseor condition in the pre-menopausal woman is endometriosis. In someembodiments, the disease or condition in the pre-menopausal woman is auterine disease or condition.

In one aspect, described herein is a compound of Formula (I), or apharmaceutically acceptable salt, solvate or prodrug thereof:

Reference to a use of a compound of Formula (I) or a composition thatincludes a compound of Formula (I) refers to a racemic mixture of thecompound.

In another aspect, described herein is the (R)-enantiomer of thecompound of Formula (I), wherein the (R)-enantiomer of the compound ofFormula (I) has the structure of Formula (II):

or a pharmaceutically acceptable salt, solvate or prodrug thereof.

Reference to a use of a compound of Formula (II) or a composition thatincludes a compound of Formula (II) refers to any optical purity of thecompound of Formula (II) in the composition, including but not limitedto optically pure compound.

In some embodiments, the enantiomeric ratio of the compound of Formula(II) is greater than 90:10. In some embodiments, the enantiomeric ratioof the compound of Formula (II) is greater than 95:5. In someembodiments, the enantiomeric ratio of the compound of Formula (II) isgreater than 99:1. In some embodiments, the compound of Formula (II) isoptically pure.

In yet another aspect, described herein is the (S)-enantiomer of thecompound of Formula (I), wherein the (S)-enantiomer of the compound ofFormula (I) has the structure of Formula (III):

-   -   or a pharmaceutically acceptable salt, solvate or prodrug        thereof.

Reference to a use of a compound of Formula (III) or a composition thatincludes a compound of Formula (III) refers to any optical purity of thecompound of Formula (III) in the composition, including but not limitedto optically pure compound.

In some embodiments, the enantiomeric ratio of the compound of Formula(III) is greater than 90:10. In some embodiments, the enantiomeric ratioof the compound of Formula (III) is greater than 95:5. In someembodiments, the enantiomeric ratio of the compound of Formula (III) isgreater than 99:1. In some embodiments, the compound of Formula (III) isoptically pure.

An additional compound for use in any of the methods, uses, formulationsor compositions described herein is2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-6-ol,or a pharmaceutically acceptable salt, solvate or prodrug thereof. Insome embodiments, the (R) enatiomer of2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-6-ol(i.e.(R)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-6-ol),or a pharmaceutically acceptable salt, solvate or prodrug thereof, isused in any of the methods, uses, formulations or compositions describedherein. Reference to a use of the (R)-enantiomer, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, or a composition thatincludes the (R)-enantiomer, or a pharmaceutically acceptable salt,solvate or prodrug thereof, refers to any optical purity of the(R)-enantiomer of the compound, or a pharmaceutically acceptable salt,solvate or prodrug thereof, in the composition, including but notlimited to optically pure compound, or a pharmaceutically acceptablesalt, solvate or prodrug thereof. In some embodiments, the enantiomericratio of the (R)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 90:10. Insome embodiments, the enantiomeric ratio of the (R)-enantiomer of thecompound, or a pharmaceutically acceptable salt, solvate or prodrugthereof, is greater than 95:5. In some embodiments, the enantiomericratio of the (R)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 99:1. Insome embodiments, the (R)-enantiomer of the compound, or apharmaceutically acceptable salt, solvate or prodrug thereof, isoptically pure. In some embodiments, the (S) enatiomer of2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-6-ol(i.e.(S)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-6-ol),or a pharmaceutically acceptable salt, solvate or prodrug thereof, isused in any of the methods, uses, formulations or compositions describedherein. Reference to a use of the (S)-enantiomer, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, or a composition thatincludes the (S)-enantiomer, or a pharmaceutically acceptable salt,solvate or prodrug thereof, refers to any optical purity of the(S)-enantiomer of the compound, or a pharmaceutically acceptable salt,solvate or prodrug thereof, in the composition, including but notlimited to optically pure compound, or a pharmaceutically acceptablesalt, solvate or prodrug thereof. In some embodiments, the enantiomericratio of the (S)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 90:10. Insome embodiments, the enantiomeric ratio of the (S)-enantiomer of thecompound, or a pharmaceutically acceptable salt, solvate or prodrugthereof, is greater than 95:5. In some embodiments, the enantiomericratio of the (S)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 99:1. Insome embodiments, the (S)-enantiomer of the compound, or apharmaceutically acceptable salt, solvate or prodrug thereof, isoptically pure.

An additional compound for use in any of the methods, uses, formulationsor compositions described herein is2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-7-ol,or a pharmaceutically acceptable salt, solvate or prodrug thereof. Insome embodiments, the (R) enatiomer of2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-7-ol(i.e.(R)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-7-ol),or a pharmaceutically acceptable salt, solvate or prodrug thereof, isused in any of the methods, uses, formulations or compositions describedherein. Reference to a use of the (R)-enantiomer, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, or a composition thatincludes the (R)-enantiomer, or a pharmaceutically acceptable salt,solvate or prodrug thereof, refers to any optical purity of the(R)-enantiomer of the compound, or a pharmaceutically acceptable salt,solvate or prodrug thereof, in the composition, including but notlimited to optically pure compound, or a pharmaceutically acceptablesalt, solvate or prodrug thereof. In some embodiments, the enantiomericratio of the (R)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 90:10. Insome embodiments, the enantiomeric ratio of the (R)-enantiomer of thecompound, or a pharmaceutically acceptable salt, solvate or prodrugthereof, is greater than 95:5. In some embodiments, the enantiomericratio of the (R)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 99:1. Insome embodiments, the (R)-enantiomer of the compound, or apharmaceutically acceptable salt, solvate or prodrug thereof, isoptically pure. In some embodiments, the (S) enatiomer of2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-7-ol(i.e.(S)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-7-ol),or a pharmaceutically acceptable salt, solvate or prodrug thereof, isused in any of the methods, uses, formulations or compositions describedherein. Reference to a use of the (S)-enantiomer, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, or a composition thatincludes the (S)-enantiomer, or a pharmaceutically acceptable salt,solvate or prodrug thereof, refers to any optical purity of the(S)-enantiomer of the compound, or a pharmaceutically acceptable salt,solvate or prodrug thereof, in the composition, including but notlimited to optically pure compound, or a pharmaceutically acceptablesalt, solvate or prodrug thereof. In some embodiments, the enantiomericratio of the (S)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 90:10. Insome embodiments, the enantiomeric ratio of the (S)-enantiomer of thecompound, or a pharmaceutically acceptable salt, solvate or prodrugthereof, is greater than 95:5. In some embodiments, the enantiomericratio of the (S)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 99:1. Insome embodiments, the (S)-enantiomer of the compound, or apharmaceutically acceptable salt, solvate or prodrug thereof, isoptically pure.

An additional compound for use in any of the methods, uses, formulationsor compositions described herein is2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-7-ol,or a pharmaceutically acceptable salt, solvate or prodrug thereof. Insome embodiments, the (R) enatiomer of2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-7-ol(i.e.(R)-2-(4-(2-(3-(Fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-7-ol),or a pharmaceutically acceptable salt, solvate or prodrug thereof, isused in any of the methods, uses, formulations or compositions describedherein. Reference to a use of the (R)-enantiomer, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, or a composition thatincludes the (R)-enantiomer, or a pharmaceutically acceptable salt,solvate or prodrug thereof, refers to any optical purity of the(R)-enantiomer of the compound, or a pharmaceutically acceptable salt,solvate or prodrug thereof, in the composition, including but notlimited to optically pure compound, or a pharmaceutically acceptablesalt, solvate or prodrug thereof. In some embodiments, the enantiomericratio of the (R)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 90:10. Insome embodiments, the enantiomeric ratio of the (R)-enantiomer of thecompound, or a pharmaceutically acceptable salt, solvate or prodrugthereof, is greater than 95:5. In some embodiments, the enantiomericratio of the (R)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 99:1. Insome embodiments, the (R)-enantiomer of the compound, or apharmaceutically acceptable salt, solvate or prodrug thereof, isoptically pure. In some embodiments, the (S) enatiomer of2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-7-ol(i.e.(S)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(4-hydroxyphenyl)-4-methyl-2H-chromen-7-ol),or a pharmaceutically acceptable salt, solvate or prodrug thereof, isused in any of the methods, uses, formulations or compositions describedherein. Reference to a use of the (S)-enantiomer, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, or a composition thatincludes the (S)-enantiomer, or a pharmaceutically acceptable salt,solvate or prodrug thereof, refers to any optical purity of the(S)-enantiomer of the compound, or a pharmaceutically acceptable salt,solvate or prodrug thereof, in the composition, including but notlimited to optically pure compound, or a pharmaceutically acceptablesalt, solvate or prodrug thereof. In some embodiments, the enantiomericratio of the (S)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 90:10. Insome embodiments, the enantiomeric ratio of the (S)-enantiomer of thecompound, or a pharmaceutically acceptable salt, solvate or prodrugthereof, is greater than 95:5. In some embodiments, the enantiomericratio of the (S)-enantiomer of the compound, or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, is greater than 99:1. Insome embodiments, the (S)-enantiomer of the compound, or apharmaceutically acceptable salt, solvate or prodrug thereof, isoptically pure.

Synthesis

Compounds described herein are synthesized using standard synthetictechniques or using methods known in the art in combination with methodsdescribed herein. In additions, solvents, temperatures and otherreaction conditions presented herein may vary.

The starting material used for the synthesis of the compounds describedherein are either synthesized or obtained from commercial sources, suchas, but not limited to, Sigma-Aldrich, Fluka, Acros Organics, AlfaAesar, and the like. The compounds described herein, and other relatedcompounds having different substituents are synthesized using techniquesand materials described herein or otherwise known, including those foundin March, ADVANCED ORGANIC CHEMISTRY 4^(th) Ed., (Wiley 1992); Carey andSundberg, ADVANCED ORGANIC CHEMISTRY 4^(th) Ed., Vols. A and B (Plenum2000, 2001), and Green and Wuts, PROTECTIVE GROUPS IN ORGANIC SYNTHESIS3^(rd) Ed., (Wiley 1999). General methods for the preparation ofcompounds can be modified by the use of appropriate reagents andconditions for the introduction of the various moieties found in theformulae as provided herein.

In some embodiments, the compounds described herein are prepared asoutlined in the following Schemes.

Treatment of phenols of structure I with phenylacetic acids of structureII in the presence of a suitable Lewis Acid in a suitable solventprovides ketones of structure III. PG represents any suitable phenolprotecting group. In some embodiments, PG is methyl, benzyl,para-methoxybenzyl or tetrahydropyran. In some embodiments the suitableLewis Acid is BF₃-Et₂O. In some embodiments, the suitable solvent istoluene, dichloromethane, or dichloroethane. In some embodiments, thereaction is heated. In some embodiments, the reaction is heated to 90°C.-100° C. Ketones of structure III are reacted with benzaldehydes ofstructure IV in the presence of a suitable base and suitable solvent toprovide compounds of structure V. In some embodiments, the suitable baseis piperidine and 1,8-diazabicyclo[5.4.0]undec-7-ene (DBU). In someembodiments, the suitable solvent is s-butanol, n-butanol, and/ori-propanol. In some embodiments, ketones of structure III are reactedwith benzaldehydes of structure IV in the presence of piperidine, DBU ins-butanol at reflux for 3 hours and then i-propanol is added and thereaction is stirred at room temperature for 1-3 days. Compounds ofstructure V are treated with suitable organometallic reagents in asuitable solvent to provide tertiary alcohols of structure Va that arethen dehydrated to provide chromenes of structure VI. In someembodiments, the suitable organometallic reagent is methyl lithium,methyl magnesium chloride, methyl magnesium bromide or methyl magnesiumiodide. In some embodiments, the suitable solvent for the formation ofthe tertiary alcohols is an aprotic solvent. In some embodiments, theaprotic solvent is tetrahydrofuran. The tertiary alcohol that isproduced is then treated with acetic acid/water to eliminate to thechromene. In some embodiments, the tertiary alcohol is treated withacetic acid/water around 90° C. to eliminate to the chromene. Theprotecting groups are then removed under standard reaction conditions.For example, when PG is a benzyl group, then the benzyl group is removedwith Pd/C, hydrogen gas, in methanol or ethyl acetate or acetic acid.Alternatively, when PG is a benzyl group, then the benzyl group isremoved with a Lewis acid, such as aluminum trichloride. In someembodiments, when PG is a para-methoxybenzyl group, thepara-methoxybenzyl group is removed with an acid, such astrifluoroacetic acid or hydrochloric acid. In some other embodiments,when PG is a tetrahydropyran group, then the tetrahydropyran group isremoved with 80% acetic acid in water. In some embodiments, when PG is amethyl group, then the methyl group is removed withtrifluoroborane-dimethyl sulfide in dichloromethane.

In some embodiments, benzaldehydes of structure IV are prepared asoutlined in Scheme 2.

In some embodiments, 4-hydroxybenzaldehyde of structure VIIa is coupledwith compound of structure VIII under suitable coupling conditions. Insome embodiments, the suitable coupling conditions include the use oftriphenylphosphine, diisopropyl azodicarboxylate and tetrahydrofuran. Insome embodiments, the coupling is performed at room temperature.

In some embodiments, 4-halobenzaldehydes of structure VIIb (e.g. whereX¹ is F, Cl, Br or I) are coupled with compound of structure VIII undersuitable coupling conditions. In some embodiments, when X¹ is I thensuitable Ullman reaction conditions are used to couple compounds ofstructure VIIb and VIII to provide compounds of structure IV. In someembodiments, when X¹ is I then the suitable reaction conditions includethe use of CuI, potassium carbonate, butyronitrile with heating to about125° C. In an alternative embodiment, when X¹ is I then the suitablereaction conditions include the use of CuI, 1,10-phenanthroline, cesiumcarbonate, m-xylenes, with heating to about 125° C. In some otherembodiments, when X¹ is Cl, Br or I then the suitable palladium mediatedreaction conditions are used to couple compounds of structure VIIb andVIII to provide compounds of structure IV. In some embodiments, when X¹is Br then the suitable reaction conditions include the use ofPd₂(dba)₃, Xantphos, cesium carbonate, and dioxane, with heating toabout 100° C. In some embodiments, when X¹ is F or Cl then suitableS_(N)AR reaction conditions are used to couple compounds of structureVIIb and VIII to provide compounds of structure IV. In some embodiments,suitable conditions for the S_(N)AR reaction conditions include the useof a base such as sodium hydride or cesium carbonate and a solvent suchas dimethylformamide, dimethylulfoxide, or any other suitable aproticsolvent. In some embodiments, when X¹ is F then the suitable reactionconditions include the use of sodium hydride and dimethylformamide orcesium carbonate and dimethylulfoxide with heating. In some embodiments,when X¹ is Cl then the suitable reaction conditions include the use ofsodium hydride and dimethylformamide with heating.

In some embodiments, compounds are prepared as outlined in Scheme 3.

In some embodiments, ketones of structure III are prepared as outlinedin Scheme 1 and then reacted with 4-iodobenzaldehyde in the presence ofa suitable base and suitable solvent to provide compounds of structureIX. In some embodiments, the suitable base is piperidine and1,8-diazabicyclo[5.4.0]undec-7-ene (DBU). In some embodiments, thesuitable solvent(s) is s-butanol and i-propanol. In other embodiments,ketones of structure III are prepared as outlined in Scheme 3 bystarting with 1,4-dimethoxybenzene (Ia) and 2-(3-methoxyphenyl)acetylchloride (IIa). In some embodiments, 1,4-dimethoxybenzene and2-(3-methoxyphenyl)acetyl chloride are treated with a suitable LewisAcid and a suitable solvent to provide trimethoxy ketones of structureIIIa. In some embodiments, the suitable Lewis Acid is aluminumtrichloride and the suitable solvent is dichloromethane. Removal of themethyl groups from the trimethoxy ketones of structure IIIa providestrihydroxy ketones of structure IIIb. In some embodiments, removal ofthe methyl groups is accomplished with the use of a suitable Lewis Acid.In some embodiments, the suitable Lewis Acids for the removal of themethyl groups is boron tribromide. Protection of the less stericallyhindered hydroxyl groups of trihydroxy ketones of structure IIIbprovides ketones of structure III. In some embodiments, the PG ofketones of structure III is tetrahydropyran. Other suitable protectinggroups are contemplated.

Compounds of structure IX are then treated with suitable organometallicreagents to provide tertiary alcohols of structure IXa, followed bydehydration of the tertiary alcohol to provide chromenes of structureXa. In some embodiments, the suitable organometallic reagent is methyllithium, methyl magnesium chloride, methyl magnesium bromide, or methylmagnesium iodide. In some embodiments, dehydration is accomplished withthe use of 80% acetic acid in water at a temperature of about 90° C. Thefree hydroxyl groups chromenes of structure Xa are protected with aprotecting group. In some embodiments, the suitable protecting group istetrahydropyran.

In some embodiments, compound of structure VIII is reacted withchromenes of structure X under Ullmann reaction conditions to givecompound of structure XI, followed by removal of the protecting groupsPG to provide chromenes of structure VI. Ullmann reaction conditionsinclude the use of copper salts. In some embodiments, the Ullmannreaction conditions include the use of CuI, K₂CO₃, and butyronitrilewith heating to about 125° C. In some embodiments, the Ullmann reactionconditions include the use of CuI, Cs₂CO₃, 1-10-phenanthroline andm-xylenes with heating to about 125° C.

In an alternative embodiment, chromenes of structure X are reacted withethane-1,2-diol under Ullmann reaction conditions to provide compound ofstructure XII, followed by conversion of the —OH to a suitable leavinggroup (LG¹) to provide chromenes of structure XIIa. In some embodiments,the Ullmann reaction conditions include the use of CuI,1,10-phenanthroline, potassium carbonate, and butyronitrile (orm-xylenes) with heating to about 125° C. Examples of suitable leavinggroups (LG¹) include —Cl, —Br, —I, —OTf, —OMs, and —OTs. In someembodiments, the —OH is converted to —OMs by treating the —OH withmethanesulfonyl chloride and triethylamine in dichloromethane at about0° C. The leaving group of chromenes of structure XIIa is then displacedwith the azetidine of structure XIII to provide chromenes of structureXI. Removal of the protecting groups PG of chromenes of structure XIprovides chromenes of structure VI.

In some embodiments, ketones of structure III are prepared as outlinedin Scheme 4: Scheme 4:

Benzoic acid compounds of structure XIV are converted to Weinreb amidesof structure XV. In some embodiments, benzoic acid compounds ofstructure XIV are treated with oxalyl chloride, dimethylformamide (DMF),dichloromethane (DCM), at room temperature for about 2 hours followed bytreatment with triethylamine (Et₃N), N,O-dimethylhydroxylamine-HCl, DCM,at 0° C. to rt for 1 hour to provide Weinreb amides of structure XV.Weinreb amides of structure XV are then treated with suitableorganometallics reagents of structure XVI to provide ketones ofstructure IIIa. In some embodiments, ketones of structure IIIa aretreated with BBr₃, DCM, −78° C. to 0° C. for about 30 minutes to provideketones of structure IIIb. Alternatively, the ketone of structure IIIais treated with AlCl₃, DCM, 0° C. to room temperature for about 30minutes to provide the ketone of structure IIIb. In some embodiments,the less sterically hindered hydroxyl groups of the ketone of structureIIIb is protected with a suitable protecting group, such astetrahydropyran.

In some embodiments, ketones of structure III are prepared as outlinedin Scheme 5:

In some embodiments, suitably protected phenols of structure XVIII aretreated with polyphosphoric acid and phenyl acetic acids of structure IIto provide ketones of structure XVII. In some embodiments, R¹⁰⁰ is aphenol protecting group. In some embodiments, R¹⁰⁰ is methyl. Ketones ofstructure XVII are then converted to ketones of structure III in ananalogous manner as outlined in Scheme 4.

In some embodiments, ketones of structure III are prepared as outlinedin Scheme 6: Scheme 6:

Alkyl esters of phenylacetic acids, such as compounds of structure XIX,are treated with a suitable base and then reacted with acid chlorides ofstructure XX to provide keto-esters that are decarboxylated to provideketones of structure XVII. In some embodiments, R¹⁰⁰ is alkyl. In someembodiments, R¹⁰⁰ is methyl. In some embodiments, the suitable base issodium hydride. In some embodiments, compounds of structure XIX arereacted with acid chlorides of structure XX in the presence of sodiumhydride in tetrahydrofuran at 0° C. to room temperature. In otherembodiments, the suitable base is lithium bis(trimethylsilyl)amide(LiHMDS). In some embodiments, compounds of structure XIX are treatedwith LiHMDS in tetrahydrofuran at −78° C. and then reacted with acidchlorides of structure XX, and the reaction mixture is warmed to roomtemperature. In some embodiments, decarboxylation of the keto-ester isaccomplished using Krapcho decarboxylation condition. In someembodiments, Krapcho decarboxylation conditions includedimethylsulfoxide with brine or lithium chloride and heating to about150° C. Other decarboxylation conditions include the use of concentratedhydrochloric acid in water or ethanol with heating. R¹⁰⁰ is then removedfrom ketones of structure XVII as described in Scheme 4 to provideketones of structure III.

In some embodiments, ketones of structure III are prepared as outlinedin Scheme 7.

In some embodiments, a palladium mediated coupling reaction betweensuitable acetophenones and phenyl halides provides ketones of structureXVII. In some embodiments, the palladium mediated coupling conditionincludes the use of Pd₂(dba)₃, BINAP, sodium tert-butoxide,tetrahydrofuran at 70° C. Ketones of structure XVII are then transformedto ketones of structure III as described previously.

In some embodiments, the substituted azetidine is prepared as outlinedin Scheme 8.

In some embodiments, azetidines of structure XXI, where R³⁰⁰ is aprotecting group such as t-BOC or Cbz, are first deprotected and thenreacted with compounds of structure XXII, where LG¹ is a leaving group,under suitable reaction conditions to provide compounds of structureXXIII. In some embodiments, when R³⁰⁰ is t-BOC then the deprotection isperformed using hydrochloric acid in methanol or dioxane at roomtemperature or using trifluoroacetic acid in dichloromethane at roomtemperature. In some other embodiments, when R³⁰⁰ is Cbz then thedeprotection is performed using Pd/C, hydrogen gas, methanol orhydrochloric acid, dioxane and heat. In some embodiments, when LG¹ is—OMs then suitable displacement reaction conditions include the use ofpotassium carbonate (or cesium carbonate or sodium hydroxide ordiisopropylethylamine) and acetonitrile (or methanol, ethanol,isopropanol, tetrahydrofuran or dioxane) with optional heating. In someembodiments, when LG¹ is —OMs then the suitable reaction conditionsinclude performing the reaction neat (i.e. amine as solvent) withheating. In some embodiments, when LG¹ is —OTf then the suitablereaction conditions include the use of diisopropylethylamine anddichloromethane with the reaction initial performed at −78° C. thenwarming to room temperature. In some embodiments, when LG¹ is Br andR²⁰⁰ is H, then the suitable reaction conditions include the use ofsodium hydroxide, in tetrahydrofuran/water at room temperature. In someother embodiments, when LG¹ is Br and R²⁰⁰ is H, then the suitablereaction conditions include the use of1,8-diazabicyclo[5.4.0]undec-7-ene (DBU) in tetrahydrofuran at roomtemperature. In some other embodiments, when LG¹ is Br and R²⁰⁰ is H,then the reaction conditions include performing the reaction in neattriethylamine or diisoproylethylamine at room temperature.

In some embodiments, R²⁰⁰ is a suitable protecting group and includes,but is not limited, tetrahydropyran (THP), benzyl, trialkylsilyl, ortrityl. In some embodiments, R²⁰⁰ is removed from compounds of structureXXIII to provide VIII. In some embodiments, when R²⁰⁰ is benzyl, thenthe benzyl is removed using Pd/C, hydrogen gas, in methanol or ethylacetate or acetic acid. In some other embodiments, when R²⁰⁰ is benzyl,then the benzyl is removed with Lewis acids such as AlCl₃. In someembodiments, when R²⁰⁰ is THP, then the THP is removed using 80% aceticacid in water. In some embodiments, when R²⁰⁰ is trityl, then the tritylis removed with hydrochloric acid in tetrahydrofuran/water.

In another embodiment, the protecting group R³⁰⁰ of azetidines ofstructure XXI is first removed, and the resulting amine is reacted withethane-1,2-diol under transition metal mediated reaction conditions toprovide VIII. In some embodiments, the transition metal mediatedreaction conditions include the use of ruthenium or iridium catalysts.

Alternatively, reaction of amines of structure XXIV with activatedalkanes of structure XXV, where LG² is a suitable leaving group, undersuitable reaction conditions provides compounds of structure XXIII.Suitable leaving groups include, chloro, bromo, iodo, tosylate (—OTs),mesylate (—OMs), and triflate (—OTf). In some embodiments, when LG² isOMs, then the suitable reaction conditions include the use of potassiumcarbonate and acetonitrile with the reaction performed at roomtemperature to 80° C. In some embodiments, when LG² is OTf, then thesuitable reaction conditions include the use of dichloromethane anddiisopropylethylamine at −78° C. followed by heating. In someembodiments, when LG² is a halogen, then the suitable reactionconditions include the use of potassium carbonate and acetonitrile atroom temperature followed by heating. In other embodiments, the suitablereaction conditions include performing the reaction without addedsolvent or base (i.e. neat conditions).

Alternatively, reaction of diacids of structure XXVI, with aceticanhydride at about 85° C. for about 30 minutes provides an anhydridewhich is then treated with amines of structure XXIV followed by aceticanhydride to provide imides of structure XXVII. In some otherembodiments, diacid chlorides of structure XXVI are reacted with aminesof structure XXIV in the presence of diisopropylethylamine indichloromethane at 0° C. to provide imides of structure XXVII. In yetother embodiments, alkyl diesters of of structure XXVI are reacted withamines of structure XXIV in the presence of ethanol or isopropanol withheating or aluminum trichloride in toluene. Imides of structure XXVIIare then reduced to provide amines of structure XXIII. In someembodiment, the reduction is performed with lithium aluminum hydride intetrahydrofuran or DIBAL in tetrahydrofuran. Other suitable reductionconditions include the use of BH₃—SMe₂, dicloromethane, with heating.

In some embodiments, amines of structure XXIV are reacted with compoundsof structure XXVIII under suitable reaction conditions to provide amidecompounds of structure XXIX. In some embodiments, the suitable reactionconditions include the use of potassium carbonate in tetrahydrofuran ordimethylformamide. In some embodiments, when LG² is OMs, then thesuitable reaction conditions include the use of potassium carbonate andacetonitrile at room temperature to about 80° C. In some embodiments,when LG² is OTf, then the suitable reaction conditions include the useof dichloromethane and diisopropylethylamine at −78° C. to heat. In someembodiments, when LG² is halogen, then the suitable reaction conditionsinclude the use of potassium carbonate and acetonitrile at roomtemperature to heat. In some embodiment, amides of structure XXIX arethen reduced to provide amines of structure XXIII as described above.

In some embodiments, fluorinated azetidines are prepared as outlined inScheme 9.

R³⁰⁰ is a suitable protecting group for the nitrogen atom of theazetidine. In some embodiments, R³⁰⁰ is t-BOC or Cbz. In someembodiments, when R³⁰⁰ is t-BOC, then the compound of structure XXX istreated with methanesulfonyl chloride, triethylamine, anddichloromethane at 0° C. to provide compounds of structure XXXI whereLG³ is OMs. In some embodiments, when R³⁰⁰ is Cbz, then the compound ofstructure XXX is treated with triflic anhydride, diisopropylethylamine,and dichloromethane at −78° C. to provide compounds of structure XXXIwhere LG³ is OTf. In some embodiments, when R³⁰⁰ is t-BOC and LG³ isOMs, then the compound of structure XXXI is treated withtetrabutylammonium fluoride in tetrahydrofuran at reflux to providecompounds of structure XXI. Alternatively compounds of structure XXI canbe prepared directly from compounds of structure XXX by use ofdiethylaminosulfur trifluoride in dichloromethane at −78° C. to roomtemperature.

In some embodiments, azetidine of structure VIII is prepared as outlinedin Scheme 10.

Azetidines of structure XXI, where R³⁰⁰ is a protecting group such ast-BOC or Cbz, are deprotected to provide an azetidine of structure XIII.In some embodiments, when R³⁰⁰ is t-BOC then the deprotection isperformed using hydrochloric acid in methanol or dioxane at roomtemperature or using trifluoroacetic acid in dichloromethane at roomtemperature. In some other embodiments, when R³⁰⁰ is Cbz then thedeprotection is performed using Pd/C, hydrogen gas, methanol orhydrochloric acid, dioxane and heat.

In some embodiments, azetidine of structure XIII is reacted with epoxideof structure XXXIII under suitable reaction conditions to provideazetidine of structure VIII. In some embodiments, the suitable reactionconditions include the use of diisopropylethylamine and dichloromethaneat room temperature or the suitable reaction conditions include the useof sodium hydroxide and tetrahydrofuran/water at room temperature oralternatively, the suitable reaction conditions include the use oftriethylamine, LiClO₄, and acetonitrile or dichloromethane, at 0° C. toroom temperature.

In other embodiments, azetidine of structure XIII is reacted withcompounds of structure XXXIV under suitable reaction conditions toprovide azetidine of structure VIII. LG¹ is a suitable leaving group.Suitable leaving groups include, chloro, bromo, iodo, tosylate (—OTs),mesylate (—OMs), and triflate (—OTf). In some embodiments, when LG¹ isBr or I, then the suitable reaction conditions include the use of anyone of the following: (i) sodium hydroxide, tetrahydrofuran/water; or(ii) sodium hydroxide, potassium iodide, tetrahydrofuran/water; or (iii)sodium hydroxide, tetrabutylammonium iodide, tetrahydrofuran/water, roomtemperature to 50° C.; or (iv) diisopropylethylamine, acetonitrile, roomtemperature to 80° C.; or (v) triethylamine, tetrahydrofuran, roomtemperature to reflux; or (vi) DBU, tetrahydrofuran, room temperature;or vii) neat amines (e.g. triethylamine or diisopropylethylamine).

In some other embodiments, azetidine of structure VIII is prepared asoutlined in Scheme 11.

In some embodiments, azetidine of structure XIII is reacted withaldehydes of structure XXXV under suitable reductive conditions toprovide compounds of structure XXIII. Suitable reductive conditionsinclude the use of: (i) NaBH(OAc)₃, acetic acid, and tetrahydrofuran; or(ii) NaCNBH₄, NaOAc, and ethanol at 0° C. to room temperature. Removalof the R²⁰⁰ group of compounds of structure XXIII may proceed asoutlined in Scheme 8 to provide azetidine compound of structure VIII.

In some other embodiments, azetidine of structure XIII is coupled withcompounds of structure XXXVII (where R²⁰⁰ is a suitable alcoholprotecting group and R is an alkyl) to provide compounds of structureXXXVIII. In some embodiments, the coupling conditions include the use oftriethylamine and tetrahydrofuran at 0° C. to room temperature ordiisopropylethylamine and dichloromethane at room temperature orpyridine and dichloromethane at 0° C. Reduction of the amide anddeprotection of the R²⁰⁰ protecting group of compounds of structureXXXVIII provides compound of structure VIII. In some embodiments, R²⁰⁰is acetyl and reduction of the amide of compounds of structure XXXVIIIis performed with lithium aluminum hydride in tetrahydrofuran at 0° C.to provide compound of structure VIII.

In an alternative embodiment, azetidine of structure XIII is coupledwith: (i) aldehydes of structure XXXIX under reductive aminationconditions; or (ii) compounds of structure XL (where X¹ is a leavinggroup such as Cl, Br or I); to provide compounds of structure XLI.Reduction of the alkyl ester of compound of structure XLI to the alcoholprovides VIII. In some embodiments, azetidine of structure XIII iscoupled with aldehydes of structure XXXIX under reductive aminationconditions that include the use of NaBH(OAc)₃, NaOAc, anddichloromethane. In some embodiments, azetidine of structure XIII iscoupled with alkyl esters of structure XL with the use of potassiumcarbonate and acetonitrile at room temperature or triethylamine andtetrahydrofuran at 0° C. to room temperature or diisopropylethylamineand dichloromethane at room temperature. Suitable reaction conditionsfor the reduction of the alkyl ester to the alcohol include the use oflithium aluminum hydride, lithium borohydride, sodium borohydride ordiisobutylaluminum hydride in a suitable solvent.

In some embodiments, azetidine of structure VIII is prepared as outlinedin Scheme 12.

Tris(hydroxymethyl)methane of structure XLIII is treated withbenzaldehyde, toluenesulfonic acid, dichloromethane and heat to providecompound of structure XLIV. The hydroxyl group of compound of structureXLIV is then converted to a fluoride group by a two step process thatfirst includes activating the hydroxyl group to a suitable leaving groupand then treatment with a suitable source of fluoride ions. In someembodiments, compound of structure XLIV is treated with methanesulfonylchloride, triethylamine, dichloromethane at 0° C. and then treated withtetrabutylammonium fluoride, tetrahydrofuran at reflux to providecompound of structure XLV. Compound of structure XLV is then treatedwith an acid to provide diol of structure XLVI. In one embodiment,compound of structure XLV is treated with: (i) hydrochloric acid,methanol, at room temperature; or (ii) hydrochloric acid, water, at roomtemperature to provide diol of structure XLVI.

In some embodiments, diol of structure XLVI is treated withmethanesulfonyl chloride, triethylamine, dichloromethane at 0° C. toroom temperature to provide compound of structure XXV, where LG² is OMs.Alternatively, diol of structure XLVI is treated with triflic anhydride,diisopropylethylamine, dichloromethane, at −78° C. to room temperatureto provide compound of structure XXV, where LG² is OTf. In someembodiments, compound of structure XXV is treated with 2-aminoethanol,acetonitrile, potassium carbonate, with heating to provide azetidine ofstructure VIII. Other aminoalcohols (e.g. 2-(benzyloxy)ethanamine orcompounds of structure XXIV) are reacted with compound of structure XXVas outlined in Scheme 8 to provide azetidine of structure VIII. In someembodiments, when LG² is OMs then compound of structure XXV is treatedwith a suitable aminoalcohol under neat conditions.

In some embodiments, compounds of structure VI are prepared as describedin Scheme 13.

In some embodiments, compounds of structure XLVII are treated withcompound of structure VIII under suitable coupling conditions to providecompounds of structure XI. In some embodiments, the suitable couplingconditions include the use of triphenylphosphine, diisopropylazodicarboxylate and tetrahydrofuran. In some embodiments, the couplingis performed at room temperature. In some embodiments, PG is methyl ortetrahydropyran.

Alternatively, reaction of phenols of structure XLVII with activatedalkanes of structure VIIIa, where LG is a suitable leaving group, undersuitable reaction conditions provides compounds of structure XI.Suitable leaving groups include, chloro, bromo, iodo, tosylate (—OTs),mesylate (—OMs), and triflate (—OTf). In some embodiments, when LG is Clor Br, then then the suitable reaction conditions include the use ofpotassium carbonate and acetonitrile (or acetone) with the reactionperformed at room temperature to reflux.

Deprotection of the protecting groups from compounds of structure XIprovides compounds of structure VI. In some embodiments, when PG istetrahydropyran then the deprotection reaction is performed with the useof 80% acetic acid in water at room temperature. In some embodiments,when PG is methyl then the deprotection reaction is performed with theuse of boron trifluoride-dimethyl sulfide in dichloromethane at roomtemperature.

In some embodiments, the phenols of structure XLVII are prepared asoutlined in Scheme 14.

In some embodiments, compounds of structure XLVIII are treated withsuitable organometallic reagents in a suitable solvent to providetertiary alcohols of structure XLIX. In some embodiments, the suitableorganometallic reagent is methyl lithium, methyl magnesium chloride,methyl magnesium bromide or methyl magnesium iodide. In someembodiments, the suitable solvent for the formation of the tertiaryalcohols is an aprotic solvent. In some embodiments, the aprotic solventis tetrahydrofuran.

In some embodiments, when PG is tetrahydropyran and PG¹ is allyl orbenzyl, then tertiary alcohols of structure XLIX are treated with 80%acetic acid in water at about 90° C. to provide dihydroxy compounds ofstructure L. In some embodiments, dihydroxy compounds of structure L aretreated with dihydropyran, pyridinium p-toluenesulfonate (PPTS) indicloromethane at room temperature to provide compounds of structure LI,where PG is tetrahydropyran.

In some embodiments, selective removal of the PG¹ protecting group fromcompounds of structure LI provides compounds of structure XLVII. In someembodiments, when PG¹ is allyl and PG is tetrahydropyran, then compoundsof structure LI are treated withtetrakis(triphenylphosphine)palladium(0), pyrrolidine in tetrahydrofuranat room temperature to provide compounds of structure XLVII. In someembodiments, when PG¹ is benzyl and PG is tetrahydropyran, thencompounds of structure LI are treated with palladium on carbon, hydrogengas in methanol at room temperature to provide compounds of structureXLVII.

In some embodiments, the protecting groups of compounds of structureXLIX are stable under acidic conditions and remain intact during thedehydration step of the tertiary alcohol. In some embodiments, suitableprotecting groups that are stable under acidic conditions includeinstances where PG is methyl or benzyl and instances where PG¹ is allyl.

An alternative method to access compounds of structure LI includes thereaction of compounds of structure X with suitable alcohols under coppercatalyzed reaction conditions. In some embodiments, compounds ofstructure X are reacted with allyl alcohol or benzyl alcohol in thepresence of copper iodide, potassium carbonate, 1,10-phenanthroline,toluene (or xylenes) at a temperature of about 110-120° C. to providecompounds of structure LI.

In some embodiments, compounds of structure XLVIII are prepared asoutline in Scheme 15.

In some embodiments, benzoyl chlorides of structure LII are reacted withcompounds of structure III to provide compounds of structure LIV. Insome embodiments, the reaction conditions to prepare compounds ofstructure LIV include the use of triethylamine in tetrahydrofuran at 0°C. to room temperature. Compounds of structure LIV are treated withlithium diisopropylamide or lithium bis(trimethylsilyl)amide intetrahydrofuran at −78° C. to room temperature to provide compounds ofstructure LV. Treatment of compounds of structure LV withtrifluoroacetic acid and triethylsilane in dichloromethane at 0° C. toroom temperature provides compounds of structure XLVIII.

Alternatively, compounds or structure III are reacted with benzaldehydesof structure LIII under suitable reaction conditions to providecompounds of structure XLVIII. In some embodiments, the suitablereaction conditions include the use of1,8-diazabicyclo[5.4.0]undec-7-ene, piperidine, and s-butanol at atemperature of about 120° C.

In one aspect, compounds described herein are synthesized as outlined inthe Examples.

Throughout the specification, groups and substituents thereof are chosenby one skilled in the field to provide stable moieties and compounds.

A detailed description of techniques applicable to the creation ofprotecting groups and their removal are described in Greene and Wuts,Protective Groups in Organic Synthesis, 3rd Ed., John Wiley & Sons, NewYork, N.Y., 1999, and Kocienski, Protective Groups, Thieme Verlag, NewYork, N.Y., 1994, which are incorporated herein by reference for suchdisclosure.

Further Forms of Compounds

In one aspect, compounds described herein exist as a racemic mixture orin enantiomerically enriched or enantiomerically pure form. In certainembodiments, compounds described herein are prepared as their individualstereoisomers by reacting a racemic mixture of the compound with anoptically active resolving agent to form a pair of diastereoisomericcompounds/salts, separating the diastereomers and recovering theoptically pure enantiomers. In some embodiments, resolution ofenantiomers is carried out using covalent diastereomeric derivatives ofthe compounds described herein. In another embodiment, diastereomers areseparated by separation/resolution techniques based upon differences insolubility. In certain embodiments, compounds described herein areprepared as their individual stereoisomers by enzymatic resolution. Insome embodiments, resolution of individual stereoisomers is carried outusing a lipase or an esterase. In some embodiments, resolution ofindividual stereoisomers is carried out by lipase or esterase-catalyzedasymmetric deacylation. In other embodiments, separation of steroisomersis performed by chromatography or by the forming diastereomeric saltsand separation by recrystallization, or chromatography, or anycombination thereof. Jean Jacques, Andre Collet, Samuel H. Wilen,“Enantiomers, Racemates and Resolutions”, John Wiley and Sons, Inc.,1981. In some embodiments, stereoisomers are obtained by stereoselectivesynthesis.

The methods and compositions described herein include the use ofamorphous forms as well as crystalline forms (also known as polymorphs).In one aspect, compounds described herein are in the form ofpharmaceutically acceptable salts. As well, active metabolites of thesecompounds having the same type of activity are included in the scope ofthe present disclosure. In addition, the compounds described herein canexist in unsolvated as well as solvated forms with pharmaceuticallyacceptable solvents such as water, ethanol, and the like. The solvatedforms of the compounds presented herein are also considered to bedisclosed herein.

In some embodiments, compounds described herein are prepared asprodrugs. A “prodrug” refers to an agent that is converted into theparent drug in vivo. Prodrugs are often useful because, in somesituations, they may be easier to administer than the parent drug. Theymay, for instance, be bioavailable by oral administration whereas theparent is not. The prodrug may also have improved solubility inpharmaceutical compositions over the parent drug. In some embodiments,the design of a prodrug increases the effective water solubility. Anexample, without limitation, of a prodrug is a compound describedherein, which is administered as an ester (the “prodrug”) but then ismetabolically hydrolyzed to provide the active entity. In someembodiments, the active entity is a phenolic compound as describedherein. A further example of a prodrug might be a short peptide(polyaminoacid) bonded to an acid group where the peptide is metabolizedto reveal the active moiety. In certain embodiments, upon in vivoadministration, a prodrug is chemically converted to the biologically,pharmaceutically or therapeutically active form of the compound. Incertain embodiments, a prodrug is enzymatically metabolized by one ormore steps or processes to the biologically, pharmaceutically ortherapeutically active form of the compound.

Prodrugs of the compounds described herein include, but are not limitedto, esters, ethers, carbonates, thiocarbonates, N-acyl derivatives,N-acyloxyalkyl derivatives, quaternary derivatives of tertiary amines,N-Mannich bases, Schiff bases, amino acid conjugates, phosphate esters,and sulfonate esters. See for example Design of Prodrugs, Bundgaard, A.Ed., Elseview, 1985 and Method in Enzymology, Widder, K. et al., Ed.;Academic, 1985, vol. 42, p. 309-396; Bundgaard, H. “Design andApplication of Prodrugs” in A Textbook of Drug Design and Development,Krosgaard-Larsen and H. Bundgaard, Ed., 1991, Chapter 5, p. 113-191; andBundgaard, H., Advanced Drug Delivery Review, 1992, 8, 1-38, each ofwhich is incorporated herein by reference. In some embodiments, ahydroxyl group in the compounds disclosed herein is used to form aprodrug, wherein the hydroxyl group is incorporated into an acyloxyalkylester, alkoxycarbonyloxyalkyl ester, alkyl ester, aryl ester, phosphateester, sugar ester, ether, and the like. In some embodiments, one orboth hydroxyl groups in the compounds disclosed herein is used to form aprodrug, wherein the hydroxyl group(s) is/are incorporated into an alkylester. In some embodiments the alkyl ester is an isopropyl ester ortert-butyl ester. In some embodiments the alkyl ester is an isopropylester.

Prodrug forms of the herein described compounds, wherein the prodrug ismetabolized in vivo to produce a compound of Formula (I), (II), or(III), as set forth herein are included within the scope of the claims.In some cases, some of the herein-described compounds may be a prodrugfor another derivative or active compound.

In some embodiments, sites on the aromatic ring portion of compoundsdescribed herein are susceptible to various metabolic reactions.Incorporation of appropriate substituents on the aromatic ringstructures will reduce, minimize or eliminate this metabolic pathway. Inspecific embodiments, the appropriate substituent to decrease oreliminate the susceptibility of the aromatic ring to metabolic reactionsis, by way of example only, a halogen, deuterium or an alkyl group.

In another embodiment, the compounds described herein are labeledisotopically (e.g. with a radioisotope) or by another other means,including, but not limited to, the use of chromophores or fluorescentmoieties, bioluminescent labels, or chemiluminescent labels.

Compounds described herein include isotopically-labeled compounds, whichare identical to those recited in the various formulae and structurespresented herein, but for the fact that one or more atoms are replacedby an atom having an atomic mass or mass number different from theatomic mass or mass number usually found in nature. Examples of isotopesthat can be incorporated into the present compounds include isotopes ofhydrogen, carbon, nitrogen, oxygen, fluorine and chlorine, such as, forexample, ²H, ³H, ¹³C, ¹⁴C, ¹⁵N, ¹⁸O, ¹⁷O, ³⁵S, ¹⁸F, ³⁶Cl. In one aspect,isotopically-labeled compounds described herein, for example those intowhich radioactive isotopes such as ³H and ¹⁴C are incorporated, areuseful in drug and/or substrate tissue distribution assays. In oneaspect, substitution with isotopes such as deuterium affords certaintherapeutic advantages resulting from greater metabolic stability, suchas, for example, increased in vivo half-life or reduced dosagerequirements. In some embodiments, one or more hydrogen atoms that arepresent in the compounds described herein is replaced with one or moredeuterium atoms.

In additional or further embodiments, the compounds described herein aremetabolized upon administration to an organism in need to produce ametabolite that is then used to produce a desired effect, including adesired therapeutic effect.

“Pharmaceutically acceptable,” as used herein, refers a material, suchas a carrier or diluent, which does not abrogate the biological activityor properties of the compound, and is relatively nontoxic, i.e., thematerial may be administered to an individual without causingundesirable biological effects or interacting in a deleterious mannerwith any of the components of the composition in which it is contained.

The term “pharmaceutically acceptable salt” refers to a formulation of acompound that does not cause significant irritation to an organism towhich it is administered and does not abrogate the biological activityand properties of the compound. In some embodiments, pharmaceuticallyacceptable salts are obtained by reacting a compound described hereinwith acids. Pharmaceutically acceptable salts are also obtained byreacting a compound described herein with a base to form a salt.

Compounds described herein may be formed as, and/or used as,pharmaceutically acceptable salts. The type of pharmaceutical acceptablesalts, include, but are not limited to: (1) acid addition salts, formedby reacting the free base form of the compound with a pharmaceuticallyacceptable: inorganic acid to form a salt such as, for example, ahydrochloric acid salt, a hydrobromic acid salt, a sulfuric acid salt, aphosphoric acid salt, a metaphosphoric acid salt, and the like; or withan organic acid to form a salt such as, for example, an acetic acidsalt, a propionic acid salt, a hexanoic acid salt, acyclopentanepropionic acid salt, a glycolic acid salt, a pyruvic acidsalt, a lactic acid salt, a malonic acid salt, a succinic acid salt, amalic acid salt, a L-malic acid salt, a maleic acid salt, an oxalic acidsalt, a fumaric acid salt, a trifluoroacetic acid salt, a tartaric acidsalt, a L-tartaric acid salt, a citric acid salt, a benzoic acid salt, a3-(4-hydroxybenzoyl)benzoic acid salt, a cinnamic acid salt, a mandelicacid salt, a methanesulfonic acid salt, an ethanesulfonic acid salt, a1,2-ethanedisulfonic acid salt, a 2-hydroxyethanesulfonic acid salt, abenzenesulfonic acid salt, a toluenesulfonic acid salt, a2-naphthalenesulfonic acid salt, a4-methylbicyclo-[2.2.2]oct-2-ene-1-carboxylic acid salt, a glucoheptonicacid salt, a 4,4′-methylenebis-(3-hydroxy-2-ene-1-carboxylic acid) salt,a 3-phenylpropionic acid salt, a trimethylacetic acid salt, a tertiarybutylacetic acid salt, a lauryl sulfuric acid salt, a gluconic acidsalt, a glutamic acid salt, a hydroxynaphthoic acid salt, a salicylicacid salt, a stearic acid salt, a muconic acid salt, a butyric acidsalt, a phenylacetic acid salt, a phenylbutyric acid salt, a valproicacid salt, and the like; (2) salts formed when an acidic proton presentin the parent compound is replaced by a metal ion, e.g., an alkali metalion (e.g. a lithium salt, a sodium salt, or a potassium salt), analkaline earth ion (e.g. a magnesium salt, or a calcium salt), or analuminum ion (e.g. an aluminum salt). In some cases, compounds describedherein are prepared as a hydrochloride salt. In some other cases,compounds described herein are prepared as a mandelate salt. In somecases, compounds described herein may coordinate with an organic base toform a salt, such as, but not limited to, an ethanolamine salt, adiethanolamine salt, a triethanolamine salt, a tromethamine salt, aN-methylglucamine salt, a dicyclohexylamine salt, or atris(hydroxymethyl)methylamine salt. In other cases, compounds describedherein may form salts with amino acids such as, but not limited to, anarginine salt, a lysine salt, and the like. Acceptable inorganic basesused to form salts with compounds that include an acidic proton,include, but are not limited to, aluminum hydroxide, calcium hydroxide,potassium hydroxide, sodium carbonate, sodium hydroxide, and the like.

It should be understood that a reference to a pharmaceuticallyacceptable salt includes the solvent addition forms. Solvates containeither stoichiometric or non-stoichiometric amounts of a solvent, andmay be formed during the process of crystallization withpharmaceutically acceptable solvents such as water, ethanol, and thelike. Hydrates are formed when the solvent is water, or alcoholates areformed when the solvent is alcohol. Solvates of compounds describedherein can be conveniently prepared or formed during the processesdescribed herein. In addition, the compounds provided herein can existin unsolvated as well as solvated forms. In some embodiments, compoundsdescribed herein are prepared are hydrates.

Certain Terminology

Unless otherwise stated, the following terms used in this application,including the specification and claims, have the definitions givenbelow. It must be noted that, as used in the specification and theappended claims, the singular forms “a,” “an” and “the” include pluralreferents unless the context clearly dictates otherwise. Unlessotherwise indicated, conventional methods of mass spectroscopy, NMR,HPLC, protein chemistry, biochemistry, recombinant DNA techniques andpharmacology are employed. In this application, the use of “or” or “and”means “and/or” unless stated otherwise. Furthermore, use of the term“including” as well as other forms, such as “include”, “includes,” and“included,” is not limiting. The section headings used herein are fororganizational purposes only and are not to be construed as limiting thesubject matter described.

An “alkyl” group refers to an aliphatic hydrocarbon group. The alkylmoiety may be branched or straight chain. The “alkyl” group may have 1to 6 carbon atoms (whenever it appears herein, a numerical range such as“1 to 6” refers to each integer in the given range; e.g., “1 to 6 carbonatoms” means that the alkyl group may consist of 1 carbon atom, 2 carbonatoms, 3 carbon atoms, etc., up to and including 6 carbon atoms,although the present definition also covers the occurrence of the term“alkyl” where no numerical range is designated). Typical alkyl groupsinclude, but are in no way limited to, methyl, ethyl, propyl, isopropyl,butyl, isobutyl, sec-butyl, tertiary butyl, pentyl, neopentyl, hexyl,and the like. In some embodiments, 1 or more hydrogen atoms of an alkylare replaced with 1 or more deuterium atoms.

The term “halo” or, alternatively, “halogen” or “halide” means fluoro(F), chloro (Cl), bromo (Br) or iodo (I).

The term “bond” or “single bond” refers to a chemical bond between twoatoms, or two moieties when the atoms joined by the bond are consideredto be part of larger substructure. In one aspect, when a group describedherein is a bond, the referenced group is absent thereby allowing a bondto be formed between the remaining identified groups.

The term “moiety” refers to a specific segment or functional group of amolecule. Chemical moieties are often recognized chemical entitiesembedded in or appended to a molecule.

The methods and formulations described herein include the use ofN-oxides (if appropriate), crystalline forms (also known as polymorphs),or pharmaceutically acceptable salts of a compound having the structureof Formula (I), (II), or (III), as well as active metabolites of thesecompounds having the same type of activity. In some situations,compounds may exist as tautomers. All tautomers are included within thescope of the compounds presented herein. In specific embodiments, thecompounds described herein exist in solvated forms with pharmaceuticallyacceptable solvents such as water, ethanol, and the like. In otherembodiments, the compounds described herein exist in unsolvated form.

The term “enantiomeric ratio” refers to ratio of the percentage of oneenantiomer in a mixture to that of the other. In some embodiments,compositions disclosed herein include a compound of Formula (III), or apharmaceutically acceptable salt, solvate or prodrug thereof, with anenantiomeric ratio of at least 80%-(S):20%-(R), at least85%-(S):15%-(R), at least 90%-(S):10%-(R), at least 95%-(S):5%-(R), atleast 99%-(S):1%-(R), or greater than 99%-(S):1%-(R). In someembodiments, compositions described herein include enantiomerically purecompound of Formula (III), or a pharmaceutically acceptable salt,solvate or prodrug thereof. In some embodiments, compositions disclosedherein include a compound of Formula (II), or a pharmaceuticallyacceptable salt, solvate or prodrug thereof, with an enantiomeric ratioof at least 80%-(R):20%-(S), at least 85%-(R):15%-(S), at least90%-(R):10%-(S), at least 95%-(R):5%-(S), at least 99%-(R):1%-(S), orgreater than 99%-(R):1%-(S). In some embodiments, compositions describedherein include enantiomerically pure compound of Formula (II), or apharmaceutically acceptable salt, solvate or prodrug thereof.

The term “acceptable” with respect to a formulation, composition oringredient, as used herein, means having no persistent detrimentaleffect on the general health of the subject being treated.

The term “modulate” as used herein, means to interact with a targeteither directly or indirectly so as to alter the activity of the target,including, by way of example only, to enhance the activity of thetarget, to inhibit the activity of the target, to limit the activity ofthe target, or to extend the activity of the target.

The term “modulator” as used herein, refers to a molecule that interactswith a target either directly or indirectly. The interactions include,but are not limited to, the interactions of an agonist, partial agonist,an inverse agonist, antagonist, degrader, or combinations thereof. Insome embodiments, a modulator is an antagonist. In some embodiments, amodulator is a degrader.

“Selective estrogen receptor modulator” or “SERM” as used herein, refersto a molecule that differentially modulates the activity of estrogenreceptors in different tissues. For example, in some embodiments, a SERMdisplays ER antagonist activity in some tissues and ER agonist activityin other tissues. In some embodiments, a SERM displays ER antagonistactivity in some tissues and minimal or no ER agonist activity in othertissues. In some embodiments, a SERM displays ER antagonist activity inbreast tissues, ovarian tissues, endometrial tissues, and/or cervicaltissues but minimal or no ER agonist activity in uterine tissues.

The term “antagonist” as used herein, refers to a small-molecule agentthat binds to a nuclear hormone receptor and subsequently decreases theagonist induced transcriptional activity of the nuclear hormonereceptor.

The term “agonist” as used herein, refers to a small-molecule agent thatbinds to a nuclear hormone receptor and subsequently increases nuclearhormone receptor transcriptional activity in the absence of a knownagonist.

The term “inverse agonist” as used herein, refers to a small-moleculeagent that binds to a nuclear hormone receptor and subsequentlydecreases the basal level of nuclear hormone receptor transcriptionalactivity that is present in the absence of a known agonist.

The term “degrader” as used herein, refers to a small molecule agentthat binds to a nuclear hormone receptor and subsequently lowers thesteady state protein levels of said receptor. In some embodiments, adegrader as described herein lowers steady state estrogen receptorlevels by at least 10%, at least 20%, at least 30%, at least 40%, atleast 50%, at least 60%, at least 65%, at least 70%, at least 75%, atleast 80%, at least 85%, at least 90% or at least 95%. In someembodiments, a degrader as described herein lowers steady state estrogenreceptor levels by at least 65%. In some embodiments, a degrader asdescribed herein lowers steady state estrogen receptor levels by atleast 85%.

The term “selective estrogen receptor degrader” or “SERD” as usedherein, refers to a small molecule agent that preferentially binds toestrogen receptors versus other receptors and subsequently lowers thesteady state estrogen receptor levels.

The term “ER-dependent”, as used herein, refers to diseases orconditions that would not occur, or would not occur to the same extent,in the absence of estrogen receptors.

The term “ER-mediated”, as used herein, refers to diseases or conditionsthat would not occur in the absence of estrogen receptors but can occurin the presence of estrogen receptors.

The term “ER-sensitive”, as used herein, refers to diseases orconditions that would not occur, or would not occur to the same extent,in the absence of estrogens.

The term “cancer” as used herein refers to an abnormal growth of cellswhich tend to proliferate in an uncontrolled way and, in some cases, tometastasize (spread). The types of cancer include, but is not limitedto, solid tumors (such as those of the bladder, bowel, brain, breast,endometrium, heart, kidney, lung, uterus, lymphatic tissue (lymphoma),ovary, pancreas or other endocrine organ (thyroid), prostate, skin(melanoma or basal cell cancer) or hematological tumors (such as theleukemias and lymphomas) at any stage of the disease with or withoutmetastases.

Additional non-limiting examples of cancers include, acute lymphoblasticleukemia, acute myeloid leukemia, adrenocortical carcinoma, anal cancer,appendix cancer, astrocytomas, atypical teratoid/rhabdoid tumor, basalcell carcinoma, bile duct cancer, bladder cancer, bone cancer(osteosarcoma and malignant fibrous histiocytoma), brain stem glioma,brain tumors, brain and spinal cord tumors, breast cancer, bronchialtumors, Burkitt lymphoma, cervical cancer, chronic lymphocytic leukemia,chronic myelogenous leukemia, colon cancer, colorectal cancer,craniopharyngioma, cutaneous T-Cell lymphoma, embryonal tumors,endometrial cancer, ependymoblastoma, ependymoma, esophageal cancer,ewing sarcoma family of tumors, eye cancer, retinoblastoma, gallbladdercancer, gastric (stomach) cancer, gastrointestinal carcinoid tumor,gastrointestinal stromal tumor (GIST), gastrointestinal stromal celltumor, germ cell tumor, glioma, hairy cell leukemia, head and neckcancer, hepatocellular (liver) cancer, hodgkin lymphoma, hypopharyngealcancer, intraocular melanoma, islet cell tumors (endocrine pancreas),Kaposi sarcoma, kidney cancer, Langerhans cell histiocytosis, laryngealcancer, leukemia, Acute lymphoblastic leukemia, acute myeloid leukemia,chronic lymphocytic leukemia, chronic myelogenous leukemia, hairy cellleukemia, liver cancer, lung cancer, non-small cell lung cancer, smallcell lung cancer, Burkitt lymphoma, cutaneous T-cell lymphoma, Hodgkinlymphoma, non-Hodgkin lymphoma, lymphoma, Waldenström macroglobulinemia,medulloblastoma, medulloepithelioma, melanoma, mesothelioma, mouthcancer, chronic myelogenous leukemia, myeloid leukemia, multiplemyeloma, nasopharyngeal cancer, neuroblastoma, non-Hodgkin lymphoma,non-small cell lung cancer, oral cancer, oropharyngeal cancer,osteosarcoma, malignant fibrous histiocytoma of bone, ovarian cancer,ovarian epithelial cancer, ovarian germ cell tumor, ovarian lowmalignant potential tumor, pancreatic cancer, papillomatosis,parathyroid cancer, penile cancer, pharyngeal cancer, pineal parenchymaltumors of intermediate differentiation, pineoblastoma and supratentorialprimitive neuroectodermal tumors, pituitary tumor, plasma cellneoplasm/multiple myeloma, pleuropulmonary blastoma, primary centralnervous system lymphoma, prostate cancer, rectal cancer, renal cell(kidney) cancer, retinoblastoma, rhabdomyosarcoma, salivary glandcancer, sarcoma, Ewing sarcoma family of tumors, sarcoma, kaposi, Sézarysyndrome, skin cancer, small cell Lung cancer, small intestine cancer,soft tissue sarcoma, squamous cell carcinoma, stomach (gastric) cancer,supratentorial primitive neuroectodermal tumors, T-cell lymphoma,testicular cancer, throat cancer, thymoma and thymic carcinoma, thyroidcancer, urethral cancer, uterine cancer, uterine sarcoma, vaginalcancer, vulvar cancer, Waldenström macroglobulinemia, Wilms tumor.

The terms “co-administration” or the like, as used herein, are meant toencompass administration of the selected therapeutic agents to a singlepatient, and are intended to include treatment regimens in which theagents are administered by the same or different route of administrationor at the same or different time.

The terms “effective amount” or “therapeutically effective amount,” asused herein, refer to a sufficient amount of an agent or a compoundbeing administered which will relieve to some extent one or more of thesymptoms of the disease or condition being treated. The result can bereduction and/or alleviation of the signs, symptoms, or causes of adisease, or any other desired alteration of a biological system. Forexample, an “effective amount” for therapeutic uses is the amount of thecomposition comprising a compound as disclosed herein required toprovide a clinically significant decrease in disease symptoms. Anappropriate “effective” amount in any individual case may be determinedusing techniques, such as a dose escalation study.

The terms “enhance” or “enhancing,” as used herein, means to increase orprolong either in potency or duration a desired effect. Thus, in regardto enhancing the effect of therapeutic agents, the term “enhancing”refers to the ability to increase or prolong, either in potency orduration, the effect of other therapeutic agents on a system. An“enhancing-effective amount,” as used herein, refers to an amountadequate to enhance the effect of another therapeutic agent in a desiredsystem.

The term “pharmaceutical combination” as used herein, means a productthat results from the mixing or combining of more than one activeingredient and includes both fixed and non-fixed combinations of theactive ingredients. The term “fixed combination” means that the activeingredients, e.g. a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, and a co-agent, are bothadministered to a patient simultaneously in the form of a single entityor dosage. The term “non-fixed combination” means that the activeingredients, e.g. a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, and a co-agent, areadministered to a patient as separate entities either simultaneously,concurrently or sequentially with no specific intervening time limits,wherein such administration provides effective levels of the twocompounds in the body of the patient. The latter also applies tococktail therapy, e.g. the administration of three or more activeingredients.

The terms “kit” and “article of manufacture” are used as synonyms.

A “metabolite” of a compound disclosed herein is a derivative of thatcompound that is formed when the compound is metabolized. The term“active metabolite” refers to a biologically active derivative of acompound that is formed when the compound is metabolized. The term“metabolized,” as used herein, refers to the sum of the processes(including, but not limited to, hydrolysis reactions and reactionscatalyzed by enzymes) by which a particular substance is changed by anorganism. Thus, enzymes may produce specific structural alterations to acompound. For example, cytochrome P450 catalyzes a variety of oxidativeand reductive reactions while uridine diphosphate glucuronyltransferasescatalyze the transfer of an activated glucuronic-acid molecule toaromatic alcohols, aliphatic alcohols, carboxylic acids, amines and freesulphydryl groups. Metabolites of the compounds disclosed herein areoptionally identified either by administration of compounds to a hostand analysis of tissue samples from the host, or by incubation ofcompounds with hepatic cells in vitro and analysis of the resultingcompounds.

The term “subject” or “patient” encompasses mammals. Examples of mammalsinclude, but are not limited to, any member of the Mammalian class:humans, non-human primates such as chimpanzees, and other apes andmonkey species; farm animals such as cattle, horses, sheep, goats,swine; domestic animals such as rabbits, dogs, and cats; laboratoryanimals including rodents, such as rats, mice and guinea pigs, and thelike. In one aspect, the mammal is a human.

The terms “treat,” “treating” or “treatment,” as used herein, includealleviating, abating or ameliorating at least one symptom of a diseasedisease or condition, preventing additional symptoms, inhibiting thedisease or condition, e.g., arresting the development of the disease orcondition, relieving the disease or condition, causing regression of thedisease or condition, relieving a condition caused by the disease orcondition, or stopping the symptoms of the disease or condition eitherprophylactically and/or therapeutically.

Routes of Administration

Suitable routes of administration include, but are not limited to, oral,intravenous, rectal, aerosol, parenteral, ophthalmic, pulmonary,transmucosal, transdermal, vaginal, otic, nasal, and topicaladministration. In addition, by way of example only, parenteral deliveryincludes intramuscular, subcutaneous, intravenous, intramedullaryinjections, as well as intrathecal, direct intraventricular,intraperitoneal, intralymphatic, and intranasal injections.

In certain embodiments, a compound as described herein is administeredin a local rather than systemic manner, for example, via injection ofthe compound directly into an organ, often in a depot preparation orsustained release formulation. In specific embodiments, long actingformulations are administered by implantation (for examplesubcutaneously or intramuscularly) or by intramuscular injection.Furthermore, in other embodiments, the drug is delivered in a targeteddrug delivery system, for example, in a liposome coated withorgan-specific antibody. In such embodiments, the liposomes are targetedto and taken up selectively by the organ. In yet other embodiments, thecompound as described herein is provided in the form of a rapid releaseformulation, in the form of an extended release formulation, or in theform of an intermediate release formulation. In yet other embodiments,the compound described herein is administered topically.

Pharmaceutical Compositions/Formulations

In some embodiments, the compounds described herein are formulated intopharmaceutical compositions. Pharmaceutical compositions are formulatedin a conventional manner using one or more pharmaceutically acceptableinactive ingredients that facilitate processing of the active compoundsinto preparations that can be used pharmaceutically. Proper formulationis dependent upon the route of administration chosen. A summary ofpharmaceutical compositions described herein can be found, for example,in Remington: The Science and Practice of Pharmacy, Nineteenth Ed(Easton, Pa.: Mack Publishing Company, 1995); Hoover, John E.,Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa.1975; Liberman, H. A. and Lachman, L., Eds., Pharmaceutical DosageForms, Marcel Decker, New York, N.Y., 1980; and Pharmaceutical DosageForms and Drug Delivery Systems, Seventh Ed. (Lippincott Williams &Wilkins 1999), herein incorporated by reference for such disclosure.

Provided herein are pharmaceutical compositions that include a compoundof Formula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, and at least one pharmaceutically acceptable inactiveingredient. In some embodiments, the compounds described herein areadministered as pharmaceutical compositions in which a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, is mixed with other active ingredients, as in combinationtherapy. In other embodiments, the pharmaceutical compositions includeother medicinal or pharmaceutical agents, carriers, adjuvants,preserving, stabilizing, wetting or emulsifying agents, solutionpromoters, salts for regulating the osmotic pressure, and/or buffers. Inyet other embodiments, the pharmaceutical compositions include othertherapeutically valuable substances.

A pharmaceutical composition, as used herein, refers to a mixture of acompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, with other chemical components (i.e.pharmaceutically acceptable inactive ingredients), such as carriers,excipients, binders, filling agents, suspending agents, flavoringagents, sweetening agents, disintegrating agents, dispersing agents,surfactants, lubricants, colorants, diluents, solubilizers, moisteningagents, plasticizers, stabilizers, penetration enhancers, wettingagents, anti-foaming agents, antioxidants, preservatives, or one or morecombination thereof. The pharmaceutical composition facilitatesadministration of the compound to a mammal.

A therapeutically effective amount can vary widely depending on theseverity of the disease, the age and relative health of the subject, thepotency of the compound used and other factors. The compounds can beused singly or in combination with one or more therapeutic agents ascomponents of mixtures.

The pharmaceutical formulations described herein are administered to asubject by appropriate administration routes, including but not limitedto, oral, parenteral (e.g., intravenous, subcutaneous, intramuscular),intranasal, buccal, topical, rectal, or transdermal administrationroutes. The pharmaceutical formulations described herein include, butare not limited to, aqueous liquid dispersions, self-emulsifyingdispersions, solid solutions, liposomal dispersions, aerosols, soliddosage forms, powders, immediate release formulations, controlledrelease formulations, fast melt formulations, tablets, capsules, pills,delayed release formulations, extended release formulations, pulsatilerelease formulations, multiparticulate formulations, and mixed immediateand controlled release formulations.

Pharmaceutical compositions including a compound of Formula (I), (II),or (III), or a pharmaceutically acceptable salt thereof, aremanufactured in a conventional manner, such as, by way of example only,by means of conventional mixing, dissolving, granulating, dragee-making,levigating, emulsifying, encapsulating, entrapping or compressionprocesses.

The pharmaceutical compositions will include at least one compound ofFormula (I), (II), or (III), as an active ingredient in free-acid orfree-base form, or in a pharmaceutically acceptable salt form. Inaddition, the methods and pharmaceutical compositions described hereininclude the use of N-oxides (if appropriate), crystalline forms,amorphous phases, as well as active metabolites of these compoundshaving the same type of activity. In some embodiments, compoundsdescribed herein exist in unsolvated form or in solvated forms withpharmaceutically acceptable solvents such as water, ethanol, and thelike. The solvated forms of the compounds presented herein are alsoconsidered to be disclosed herein.

The pharmaceutical compositions described herein, which include acompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, are formulated into any suitable dosage form,including but not limited to, aqueous oral dispersions, liquids, gels,syrups, elixirs, slurries, suspensions, solid oral dosage forms,controlled release formulations, fast melt formulations, effervescentformulations, lyophilized formulations, tablets, powders, pills,dragees, capsules, delayed release formulations, extended releaseformulations, pulsatile release formulations, multiparticulateformulations, and mixed immediate release and controlled releaseformulations.

Pharmaceutical preparations that are administered orally includepush-fit capsules made of gelatin, as well as soft, sealed capsules madeof gelatin and a plasticizer, such as glycerol or sorbitol. The push-fitcapsules contain the active ingredients in admixture with filler such aslactose, binders such as starches, and/or lubricants such as talc ormagnesium stearate and, optionally, stabilizers. In some embodiments,the push-fit capsules do not include any other ingredient besides thecapsule shell and the active ingredient. In soft capsules, the activecompounds are dissolved or suspended in suitable liquids, such as fattyoils, liquid paraffin, or liquid polyethylene glycols. In someembodiments, stabilizers are added.

All formulations for oral administration are in dosages suitable forsuch administration.

In one aspect, solid oral soage forms are prepared by mixing a compoundof Formula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, with one or more of the following: antioxidants, flavoringagents, and carrier materials such as binders, suspending agents,disintegration agents, filling agents, surfactants, solubilizers,stabilizers, lubricants, wetting agents, and diluents.

In some embodiments, the solid dosage forms disclosed herein are in theform of a tablet, (including a suspension tablet, a fast-melt tablet, abite-disintegration tablet, a rapid-disintegration tablet, aneffervescent tablet, or a caplet), a pill, a powder, a capsule, soliddispersion, solid solution, bioerodible dosage form, controlled releaseformulations, pulsatile release dosage forms, multiparticulate dosageforms, beads, pellets, granules. In other embodiments, thepharmaceutical formulation is in the form of a powder. In still otherembodiments, the pharmaceutical formulation is in the form of a tablet.In other embodiments, pharmaceutical formulation is in the form of acapsule.

In some embodiments, solid dosage forms, e.g., tablets, effervescenttablets, and capsules, are prepared by mixing particles of a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, with one or more pharmaceutical excipients to form a bulk blendcomposition. The bulk blend is readily subdivided into equally effectiveunit dosage forms, such as tablets, pills, and capsules. In someembodiments, the individual unit dosages include film coatings. Theseformulations are manufactured by conventional formulation techniques.

Conventional formulation techniques include, e.g., one or a combinationof methods: (1) dry mixing, (2) direct compression, (3) milling, (4) dryor non-aqueous granulation, (5) wet granulation, or (6) fusion. Othermethods include, e.g., spray drying, pan coating, melt granulation,granulation, fluidized bed spray drying or coating (e.g., wurstercoating), tangential coating, top spraying, tableting, extruding and thelike.

In some embodiments, tablets will include a film surrounding the finalcompressed tablet. In some embodiments, the film coating can provide adelayed release of the compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, from the formulation. In otherembodiments, the film coating aids in patient compliance (e.g., Opadry®coatings or sugar coating). Film coatings including Opadry® typicallyrange from about 1% to about 3% of the tablet weight.

A capsule may be prepared, for example, by placing the bulk blend of theformulation of the compound described above, inside of a capsule. Insome embodiments, the formulations (non-aqueous suspensions andsolutions) are placed in a soft gelatin capsule. In other embodiments,the formulations are placed in standard gelatin capsules or non-gelatincapsules such as capsules comprising HPMC. In other embodiments, theformulation is placed in a sprinkle capsule, wherein the capsule isswallowed whole or the capsule is opened and the contents sprinkled onfood prior to eating.

In various embodiments, the particles of the compound of Formula (I),(II), or (III), or a pharmaceutically acceptable salt thereof, and oneor more excipients are dry blended and compressed into a mass, such as atablet, having a hardness sufficient to provide a pharmaceuticalcomposition that substantially disintegrates within less than about 30minutes, less than about 35 minutes, less than about 40 minutes, lessthan about 45 minutes, less than about 50 minutes, less than about 55minutes, or less than about 60 minutes, after oral administration,thereby releasing the formulation into the gastrointestinal fluid.

In still other embodiments, effervescent powders are also prepared.Effervescent salts have been used to disperse medicines in water fororal administration.

In some embodiments, the pharmaceutical solid oral dosage forms areformulated to provide a controlled release of the active compound.Controlled release refers to the release of the active compound from adosage form in which it is incorporated according to a desired profileover an extended period of time. Controlled release profiles include,for example, sustained release, prolonged release, pulsatile release,and delayed release profiles. In contrast to immediate releasecompositions, controlled release compositions allow delivery of an agentto a subject over an extended period of time according to apredetermined profile. Such release rates can provide therapeuticallyeffective levels of agent for an extended period of time and therebyprovide a longer period of pharmacologic response while minimizing sideeffects as compared to conventional rapid release dosage forms. Suchlonger periods of response provide for many inherent benefits that arenot achieved with the corresponding short acting, immediate releasepreparations.

In some embodiments, the solid dosage forms described herein areformulated as enteric coated delayed release oral dosage forms, i.e., asan oral dosage form of a pharmaceutical composition as described hereinwhich utilizes an enteric coating to affect release in the smallintestine or large intestine. In one aspect, the enteric coated dosageform is a compressed or molded or extruded tablet/mold (coated oruncoated) containing granules, powder, pellets, beads or particles ofthe active ingredient and/or other composition components, which arethemselves coated or uncoated. In one aspect, the enteric coated oraldosage form is in the form of a capsule containing pellets, beads orgranules.

Conventional coating techniques such as spray or pan coating areemployed to apply coatings. The coating thickness must be sufficient toensure that the oral dosage form remains intact until the desired siteof topical delivery in the intestinal tract is reached.

In other embodiments, the formulations described herein are deliveredusing a pulsatile dosage form. A pulsatile dosage form is capable ofproviding one or more immediate release pulses at predetermined timepoints after a controlled lag time or at specific sites. Exemplarypulsatile dosage forms and methods of their manufacture are disclosed inU.S. Pat. Nos. 5,011,692, 5,017,381, 5,229,135, 5,840,329 and 5,837,284.In one embodiment, the pulsatile dosage form includes at least twogroups of particles, (i.e. multiparticulate) each containing theformulation described herein. The first group of particles provides asubstantially immediate dose of the active compound upon ingestion by amammal. The first group of particles can be either uncoated or include acoating and/or sealant. In one aspect, the second group of particlescomprises coated particles. The coating on the second group of particlesprovides a delay of from about 2 hours to about 7 hours followingingestion before release of the second dose. Suitable coatings forpharmaceutical compositions are described herein or in the art.

In some embodiments, pharmaceutical formulations are provided thatinclude particles of a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, and at least one dispersingagent or suspending agent for oral administration to a subject. Theformulations may be a powder and/or granules for suspension, and uponadmixture with water, a substantially uniform suspension is obtained.

In one aspect, liquid formulation dosage forms for oral administrationare in the form of aqueous suspensions selected from the groupincluding, but not limited to, pharmaceutically acceptable aqueous oraldispersions, emulsions, solutions, elixirs, gels, and syrups. See, e.g.,Singh et al., Encyclopedia of Pharmaceutical Technology, 2nd Ed., pp.754-757 (2002). In addition to the particles of the compound of Formula(I), the liquid dosage forms include additives, such as: (a)disintegrating agents; (b) dispersing agents; (c) wetting agents; (d) atleast one preservative, (e) viscosity enhancing agents, (f) at least onesweetening agent, and (g) at least one flavoring agent. In someembodiments, the aqueous dispersions can further include a crystallineinhibitor.

Buccal formulations that include a compound of Formula (I), (II), or(III), or a pharmaceutically acceptable salt thereof, are administeredusing a variety of formulations known in the art. For example, suchformulations include, but are not limited to, U.S. Pat. Nos. 4,229,447,4,596,795, 4,755,386, and 5,739,136. In addition, the buccal dosageforms described herein can further include a bioerodible (hydrolysable)polymeric carrier that also serves to adhere the dosage form to thebuccal mucosa. For buccal or sublingual administration, the compositionsmay take the form of tablets, lozenges, or gels formulated in aconventional manner.

In some embodiments, compounds of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, are prepared as transdermaldosage forms. In one embodiment, the transdermal formulations describedherein include at least three components: (1) a formulation of acompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof; (2) a penetration enhancer; and (3) an aqueousadjuvant. In some embodiments the transdermal formulations includeadditional components such as, but not limited to, gelling agents,creams and ointment bases, and the like. In some embodiments, thetransdermal formulation further includes a woven or non-woven backingmaterial to enhance absorption and prevent the removal of thetransdermal formulation from the skin. In other embodiments, thetransdermal formulations described herein can maintain a saturated orsupersaturated state to promote diffusion into the skin.

In one aspect, formulations suitable for transdermal administration ofcompounds described herein employ transdermal delivery devices andtransdermal delivery patches and can be lipophilic emulsions orbuffered, aqueous solutions, dissolved and/or dispersed in a polymer oran adhesive. In one aspect, such patches are constructed for continuous,pulsatile, or on demand delivery of pharmaceutical agents. Stillfurther, transdermal delivery of the compounds described herein can beaccomplished by means of iontophoretic patches and the like. In oneaspect, transdermal patches provide controlled delivery of the activecompound. In one aspect, transdermal devices are in the form of abandage comprising a backing member, a reservoir containing the compoundoptionally with carriers, optionally a rate controlling barrier todeliver the compound to the skin of the host at a controlled andpredetermined rate over a prolonged period of time, and means to securethe device to the skin.

In one aspect, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is formulated into apharmaceutical composition suitable for intramuscular, subcutaneous, orintravenous injection. In one aspect, formulations suitable forintramuscular, subcutaneous, or intravenous injection includephysiologically acceptable sterile aqueous or non-aqueous solutions,dispersions, suspensions or emulsions, and sterile powders forreconstitution into sterile injectable solutions or dispersions.Examples of suitable aqueous and non-aqueous carriers, diluents,solvents, or vehicles include water, ethanol, polyols (propyleneglycol,polyethylene-glycol, glycerol, cremophor and the like), vegetable oilsand organic esters, such as ethyl oleate. In some embodiments,formulations suitable for subcutaneous injection contain additives suchas preserving, wetting, emulsifying, and dispensing agents. Prolongedabsorption of the injectable pharmaceutical form can be brought about bythe use of agents delaying absorption, such as aluminum monostearate andgelatin.

For intravenous injections, compounds described herein are formulated inaqueous solutions, preferably in physiologically compatible buffers suchas Hank's solution, Ringer's solution, or physiological saline buffer.

For transmucosal administration, penetrants appropriate to the barrierto be permeated are used in the formulation. Such penetrants aregenerally known in the art. For other parenteral injections, appropriateformulations include aqueous or nonaqueous solutions, preferably withphysiologically compatible buffers or excipients. Such excipients areknown.

Parenteral injections may involve bolus injection or continuousinfusion. Formulations for injection may be presented in unit dosageform, e.g., in ampoules or in multi-dose containers, with an addedpreservative. The pharmaceutical composition described herein may be ina form suitable for parenteral injection as a sterile suspensions,solutions or emulsions in oily or aqueous vehicles, and may containformulatory agents such as suspending, stabilizing and/or dispersingagents. In one aspect, the active ingredient is in powder form forconstitution with a suitable vehicle, e.g., sterile pyrogen-free water,before use.

In certain embodiments, delivery systems for pharmaceutical compoundsmay be employed, such as, for example, liposomes and emulsions. Incertain embodiments, compositions provided herein can also include anmucoadhesive polymer, selected from among, for example,carboxymethylcellulose, carbomer (acrylic acid polymer),poly(methylmethacrylate), polyacrylamide, polycarbophil, acrylicacid/butyl acrylate copolymer, sodium alginate and dextran.

In some embodiments, the compounds described herein may be administeredtopically and can be formulated into a variety of topicallyadministrable compositions, such as solutions, suspensions, lotions,gels, pastes, medicated sticks, balms, creams or ointments. Suchpharmaceutical compounds can contain solubilizers, stabilizers, tonicityenhancing agents, buffers and preservatives.

Methods of Dosing and Treatment Regimens

In one embodiment, the compounds of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, are used in the preparation ofmedicaments for the treatment of diseases or conditions in a mammal thatwould benefit from a reduction of estrogen receptor activity. Methodsfor treating any of the diseases or conditions described herein in amammal in need of such treatment, involves administration ofpharmaceutical compositions that include at least one compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, or a pharmaceutically acceptable salt, active metabolite,prodrug, or pharmaceutically acceptable solvate thereof, intherapeutically effective amounts to said mammal.

In certain embodiments, the compositions containing the compound(s)described herein are administered for prophylactic and/or therapeutictreatments. In certain therapeutic applications, the compositions areadministered to a patient already suffering from a disease or condition,in an amount sufficient to cure or at least partially arrest at leastone of the symptoms of the disease or condition. Amounts effective forthis use depend on the severity and course of the disease or condition,previous therapy, the patient's health status, weight, and response tothe drugs, and the judgment of the treating physician. Therapeuticallyeffective amounts are optionally determined by methods including, butnot limited to, a dose escalation clinical trial.

In prophylactic applications, compositions containing the compoundsdescribed herein are administered to a patient susceptible to orotherwise at risk of a particular disease, disorder or condition. Suchan amount is defined to be a “prophylactically effective amount ordose.” In this use, the precise amounts also depend on the patient'sstate of health, weight, and the like. When used in a patient, effectiveamounts for this use will depend on the severity and course of thedisease, disorder or condition, previous therapy, the patient's healthstatus and response to the drugs, and the judgment of the treatingphysician. In one aspect, prophylactic treatments include admistering toa mammal, who previously experienced at least one symtom of the diseasebeing treated and is currently in remission, a pharmaceuticalcomposition comprising a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, in order to prevent a returnof the symptoms of the disease or condition.

In certain embodiments wherein the patient's condition does not improve,upon the doctor's discretion the administration of the compounds areadministered chronically, that is, for an extended period of time,including throughout the duration of the patient's life in order toameliorate or otherwise control or limit the symptoms of the patient'sdisease or condition.

In certain embodiments wherein a patient's status does improve, the doseof drug being administered may be temporarily reduced or temporarilysuspended for a certain length of time (i.e., a “drug holiday”). Inspecific embodiments, the length of the drug holiday is between 2 daysand 1 year, including by way of example only, 2 days, 3 days, 4 days, 5days, 6 days, 7 days, 10 days, 12 days, 15 days, 20 days, 28 days, ormore than 28 days. The dose reduction during a drug holiday is, by wayof example only, by 10%-100%, including by way of example only 10%, 15%,20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%,90%, 95%, and 100%.

Once improvement of the patient's conditions has occurred, a maintenancedose is administered if necessary. Subsequently, in specificembodiments, the dosage or the frequency of administration, or both, isreduced, as a function of the symptoms, to a level at which the improveddisease, disorder or condition is retained. In certain embodiments,however, the patient requires intermittent treatment on a long-termbasis upon any recurrence of symptoms.

The amount of a given agent that corresponds to such an amount variesdepending upon factors such as the particular compound, diseasecondition and its severity, the identity (e.g., weight, sex) of thesubject or host in need of treatment, but can nevertheless be determinedaccording to the particular circumstances surrounding the case,including, e.g., the specific agent being administered, the route ofadministration, the condition being treated, and the subject or hostbeing treated.

In general, however, doses employed for adult human treatment aretypically in the range of 0.01 mg-5000 mg per day. In one aspect, dosesemployed for adult human treatment are from about 1 mg to about 1000 mgper day. In some embodiments, daily dosages appropriate for the compoundof Formula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, described herein are from about 1 mg per day to about 1000 mgper day. In some embodiments, daily dosages appropriate for the compoundof Formula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, described herein are from about 10 mg per day to about 1000 mgper day, from about 10 mg per day to about 900 mg per day, from about 10mg per day to about 800 mg per day, from about 10 mg per day to about700 mg per day, from about 10 mg per day to about 600 mg per day, fromabout 10 mg per day to about 500 mg per day, from about 10 mg per day toabout 400 mg per day, from about 50 mg per day to about 500 mg per day,or from about 100 mg per day to about 400 mg per day. In someembodiments, daily dosages appropriate for the compound of Formula (I),(II), or (III), or a pharmaceutically acceptable salt thereof, describedherein are from about 100 mg per day to about 300 mg per day. In someembodiments, daily dosages appropriate for the compound of Formula (I),(II), or (III), or a pharmaceutically acceptable salt thereof, describedherein are from about 1 mg per day, 5 mg per day, 10 mg per day, 20 mgper day, 30 mg per day, 40 mg per day, 50 mg per day, 60 mg per day, 70mg per day, 80 mg per day, 90 mg per day, 100 mg per day, 110 mg perday, 120 mg per day, 130 mg per day, 140 mg per day, 150 mg per day, 160mg per day, 170 mg per day, 180 mg per day, 190 mg per day, 200 mg perday, 210 mg per day, 220 mg per day, 230 mg per day, 240 mg per day, 250mg per day, 260 mg per day, 270 mg per day, 280 mg per day, 290 mg perday, 300 mg per day, 310 mg per day, 320 mg per day, 330 mg per day, 340mg per day, 350 mg per day, 360 mg per day, 370 mg per day, 380 mg perday, 390 mg per day, 400 mg per day, 410 mg per day, 420 mg per day, 430mg per day, 440 mg per day, 450 mg per day, 460 mg per day, 470 mg perday, 480 mg per day, 490 mg per day, 500 mg per day, 510 mg per day, 520mg per day, 530 mg per day, 540 mg per day, 550 mg per day, 560 mg perday, 570 mg per day, 580 mg per day, 590 mg per day, 600 mg per day, 610mg per day, 620 mg per day, 630 mg per day, 640 mg per day, 650 mg perday, 660 mg per day, 670 mg per day, 680 mg per day, 690 mg per day, 700mg per day, 710 mg per day, 720 mg per day, 730 mg per day, 740 mg perday, 750 mg per day, 760 mg per day, 770 mg per day, 780 mg per day, 790mg per day, 800 mg per day, 810 mg per day, 820 mg per day, 830 mg perday, 840 mg per day, 850 mg per day, 860 mg per day, 870 mg per day, 880mg per day, 890 mg per day, 900 mg per day, 910 mg per day, 920 mg perday, 930 mg per day, 940 mg per day, 950 mg per day, 960 mg per day, 970mg per day, 980 mg per day, 990 mg per day, or 1000 mg per day. In oneembodiment, the desired dose is conveniently presented in a single doseor in divided doses administered simultaneously or at appropriateintervals, for example as two, three, four or more sub-doses per day.

In some embodiments, the daily dosages appropriate for the compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, described herein are administered once a day, twice a day, orthree times a day. In some embodiments, the daily dosages appropriatefor the compound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, described herein are administered once a day.In some embodiments, the daily dosages appropriate for the compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, described herein are administered twice a day.

In one embodiment, the daily dosages appropriate for the compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, described herein are from about 0.01 to about 10 mg/kg per bodyweight. In some embodiments, the daily dosage or the amount of active inthe dosage form are lower or higher than the ranges indicated herein,based on a number of variables in regard to an individual treatmentregime. In various embodiments, the daily and unit dosages are altereddepending on a number of variables including, but not limited to, theactivity of the compound used, the disease or condition to be treated,the mode of administration, the requirements of the individual subject,the severity of the disease or condition being treated, and the judgmentof the practitioner.

Toxicity and therapeutic efficacy of such therapeutic regimens aredetermined by standard pharmaceutical procedures in cell cultures orexperimental animals, including, but not limited to, the determinationof the LD₅₀ and the ED₅₀. The dose ratio between the toxic andtherapeutic effects is the therapeutic index and it is expressed as theratio between LD₅₀ and ED₅₀. In certain embodiments, the data obtainedfrom cell culture assays and animal studies are used in formulating thetherapeutically effective daily dosage range and/or the therapeuticallyeffective unit dosage amount for use in mammals, including humans. Insome embodiments, the daily dosage amount of the compounds describedherein lies within a range of circulating concentrations that includethe ED₅₀ with minimal toxicity. In certain embodiments, the daily dosagerange and/or the unit dosage amount varies within this range dependingupon the dosage form employed and the route of administration utilized.

In some embodiments, CA-125 blood levels are monitored in humans thatare administered (or considered as candidates for treatment with) acompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof. CA-125 (also known as mucin-16) is aglycoprotein in humans. In some embodiments, CA-125 levels are elevatedin the blood of patients with certain type of cancers. In someembodiments, CA-125 is used as a serum biomarker in patients withcertain type of cancers. In some embodiments, the certain types ofcancers include, but are not limited to, breast cancer, ovarian cancer,endometrial (uterine) cancer, prostate cancer, and lung cancer. In someembodiments, monitoring CA-125 levels in the blood is used to determinethe tumor burden in a human. In some embodiments, monitoring CA-125levels in the blood is used to determine when to give a humananti-cancer therapy (e.g. a compound of Formula (I), (II), or (III), ora pharmaceutically acceptable salt thereof). In some embodiments,monitoring CA-125 levels in the blood is used to determine how a humanis responding to anti-cancer therapy (e.g. a compound of Formula (I),(II), or (III), or a pharmaceutically acceptable salt thereof). In someembodiments, CA-125 is used as a biomarker for the diagnosis andmanagement of ovarian cancer. Rising levels of CA-125 after radiationtherapy or surgery with no detectable metastases could indicaterecurrent ovarian cancer and the need to start anti-cancer treatment.

In certain embodiments, CA-125 levels are used to select patients withcancer for treatment with a compound of Formula (I), (II), or (III), ora pharmaceutically acceptable salt thereof. In some embodiments, acompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, is admistered to a human that is diagnosed withcancer, wherein the CA-125 levels in blood samples from the human arerising. In some embodiments, the cancer is breast cancer or ovariancancer or endometrial cancer. In some embodiments, the cancer is ovariancancer. In some embodiments, the human with ovarian cancer haspreviously undergone a hysterectomy and/or a bilateralsalpingo-oophorectomy. In some embodiments, the ovarian cancer patienthas previously been treated with chemotherapy. In some embodiments, theovarian cancer is recurrent ovarian cancer. In some embodiments, therecurrent ovarian cancer is treated with endocrine therapy (e.g. acompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof) before metastases develop and treatment withchemotherapy is required. In some embodiments, treatment with a compoundof Formula (I), (II), or (III), or a pharmaceutically acceptable saltthereof delays the development of distant metastases.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered to humansdiagnosed with cancer and a CA-125 serum concentration doubling time ofless than 10 days, less than 20 days, less than 30 days, less than 40days, less than 50 days, less than 60 days, less than 70 days, less than80 days, less than 90 days or less than 100 days. In some embodiments,CA-125 doubling time is less than 40 days. In some embodiments, thecancer is breast cancer, ovarian cancer, endometrial (uterine) cancer,prostate cancer, or lung cancer. In some embodiments, the cancer isovarian cancer.

Combination Treatments

In certain instances, it is appropriate to administer at least onecompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, in combination with one or more othertherapeutic agents.

In one embodiment, the therapeutic effectiveness of one of the compoundsdescribed herein is enhanced by administration of an adjuvant (i.e., byitself the adjuvant may have minimal therapeutic benefit, but incombination with another therapeutic agent, the overall therapeuticbenefit to the patient is enhanced). Or, in some embodiments, thebenefit experienced by a patient is increased by administering one ofthe compounds described herein with another therapeutic agent (whichalso includes a therapeutic regimen) that also has therapeutic benefit.

In one specific embodiment, a compound of Formula (I), (II), or (III),or a pharmaceutically acceptable salt thereof, is co-administered with asecond therapeutic agent, wherein the compound of Formula (I), (II), or(III), or a pharmaceutically acceptable salt thereof, and the secondtherapeutic agent modulate different aspects of the disease, disorder orcondition being treated, thereby providing a greater overall benefitthan administration of either therapeutic agent alone.

In any case, regardless of the disease, disorder or condition beingtreated, the overall benefit experienced by the patient may simply beadditive of the two therapeutic agents or the patient may experience asynergistic benefit.

In certain embodiments, different therapeutically-effective dosages ofthe compounds disclosed herein will be utilized in formulatingpharmaceutical composition and/or in treatment regimens when thecompounds disclosed herein are administered in combination with one ormore additional agent, such as an additional therapeutically effectivedrug, an adjuvant or the like. Therapeutically-effective dosages ofdrugs and other agents for use in combination treatment regimens can bedetermined by means similar to those set forth hereinabove for theactives themselves. Furthermore, the methods of prevention/treatmentdescribed herein encompasses the use of metronomic dosing, i.e.,providing more frequent, lower doses in order to minimize toxic sideeffects. In some embodiments, a combination treatment regimenencompasses treatment regimens in which administration of a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, is initiated prior to, during, or after treatment with a secondagent described herein, and continues until any time during treatmentwith the second agent or after termination of treatment with the secondagent. It also includes treatments in which a compound of Formula (I),(II), or (III), or a pharmaceutically acceptable salt thereof, and thesecond agent being used in combination are administered simultaneouslyor at different times and/or at decreasing or increasing intervalsduring the treatment period. Combination treatment further includesperiodic treatments that start and stop at various times to assist withthe clinical management of the patient.

It is understood that the dosage regimen to treat, prevent, orameliorate the condition(s) for which relief is sought, is modified inaccordance with a variety of factors (e.g. the disease, disorder orcondition from which the subject suffers; the age, weight, sex, diet,and medical condition of the subject). Thus, in some instances, thedosage regimen actually employed varies and, in some embodiments,deviates from the dosage regimens set forth herein.

For combination therapies described herein, dosages of theco-administered compounds vary depending on the type of co-drugemployed, on the specific drug employed, on the disease or conditionbeing treated and so forth. In additional embodiments, whenco-administered with one or more other therapeutic agents, the compoundprovided herein is administered either simultaneously with the one ormore other therapeutic agents, or sequentially.

In combination therapies, the multiple therapeutic agents (one of whichis one of the compounds described herein) are administered in any orderor even simultaneously. If administration is simultaneous, the multipletherapeutic agents are, by way of example only, provided in a single,unified form, or in multiple forms (e.g., as a single pill or as twoseparate pills).

The compound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, as well as combination therapies, isadministered before, during or after the occurrence of a disease orcondition, and the timing of administering the composition containing acompound varies. Thus, in one embodiment, the compounds described hereinare used as a prophylactic and are administered continuously to subjectswith a propensity to develop conditions or diseases in order to preventthe occurrence of the disease or condition. In another embodiment, thecompounds and compositions are administered to a subject during or assoon as possible after the onset of the symptoms. In specificembodiments, a compound described herein is administered as soon as ispracticable after the onset of a disease or condition is detected orsuspected, and for a length of time necessary for the treatment of thedisease. In some embodiments, the length required for treatment varies,and the treatment length is adjusted to suit the specific needs of eachsubject. For example, in specific embodiments, a compound describedherein or a formulation containing the compound is administered for atleast 2 weeks, about 1 month to about 5 years.

Exemplary Agents for Use in Combination Therapy

In some embodiments, methods for treatment of estrogenreceptor-dependent or estrogen receptor-mediated conditions or diseases,such as proliferative disorders, including cancer, comprisesadministration to a mammal a compound of Formula (I), (II), or (III), ora pharmaceutically acceptable salt thereof, in combination with at leastone additional therapeutic agent.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in combination withone or more additional therapeutically active agents selected from:corticosteroids, anti-emetic agents, analgesics, anti-cancer agents,anti-inflammatories, kinase inhibitors, antibodies, HSP90 inhibitors,histone deacetylase (HDAC) inhibitors, modulators of the immune system,PD-1 inhibitors, poly ADP-ribose polymerase (PARP) inhibitors, andaromatase inhibitors.

In certain instances, it is appropriate to administer at least onecompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, in combination with one or more othertherapeutic agents. In certain embodiments, the one or more othertherapeutic agents is an anti-cancer agent(s).

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in combination with anaromatase inhibitor, a phosphoinositide 3-kinase (PI3K)/mTOR pathwayinhibitor, a CDK 4/6 inhibitor, a HER-2 inhibitor, an EGFR inhibitor, aPD-1 inhibitor, poly ADP-ribose polymerase (PARP) inhibitor, a histonedeacetylase (HDAC) inhibitor, an HSP90 inhibitor, a VEGFR inhibitor, anAKT inhibitor, chemotherapy, or any combination thereof.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in combination withhormone blocking therapy, chemotherapy, radiation therapy, monoclonalantibodies, or combinations thereof.

Hormone blocking therapy includes the use of agents that block theproduction of estrogens or block the estrogen receptors. In someembodiments, hormone blocking therapy includes the use of estrogenreceptor modulators and/aromatase inhibitors. Estrogen receptormodulators include triphenylethylene derivatives (e.g. tamoxifen,toremifene, droloxifene, 3-hydroxytamoxifen, idoxifene, TAT-59 (aphosphorylated derivative of 4-hydroxytamoxifen) and GW5638 (acarboxylic acid derivative of tamoxifen)); non-steroidal estrogenreceptor modulators (e.g. raloxifene, LY353381 (SERM3) and LY357489);steroidal estrogen receptor modulators (e.g. ICI-182,780). Aromataseinhibitors include steroidal aromatase inhibitors and non-steroidalaromatase inhibitors. Steroidal aromatase inhibitors include, but arenot limited to, such exemestane. Non-steroidal aromatase inhibitorsinclude, but are not limited to, as anastrozole, and letrozole.

Chemotherapy Includes the Use of Anti-Cancer Agents.

Monoclonal antibodies include, but are not limited to, trastuzumab(Herceptin).

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in combination with atleast one additional therapeutic agent selected from: abiraterone;abarelix; adriamycin; aactinomycin; acivicin; aclarubicin; acodazolehydrochloride; acronine; adozelesin; aldesleukin; alemtuzumab;allopurinol; alitretinoin; altretamine; ambomycin; ametantrone acetate;aminoglutethimide; aminolevulinic acid; amifostine; amsacrine;anastrozole; anthramycin; aprepitant; arsenic trioxide; asparaginase;asperlin; azacitidine; AZD6244; azetepa; azotomycin; batimastat;bendamustine hydrochloride; benzodepa; bevacizumab; bexarotene;bicalutamide; bisantrene hydrochloride; bisnafide dimesylate; bizelesin;bleomycin; bleomycin sulfate; bortezomib; bosutinib; brequinar sodium;bropirimine; busulfan; cabozantinib; cactinomycin; calusterone;caracemide; carbetimer; carboplatin; carmustine; carubicinhydrochloride; carzelesin; capecitabine; cedefingol; cetuximab;chlorambucil; cirolemycin; cisplatin; cladribine; clofarabine; crisnatolmesylate; cyclophosphamide; cytarabine; dacarbazine; dasatinib;daunorubicin hydrochloride; dactinomycin; darbepoetin alfa; decitabine;degarelix; denileukin diftitox; dinaciclib; dexormaplatin; dexrazoxanehydrochloride; dezaguanine; dezaguanine mesylate; diaziquone; docetaxel;doxorubicin; doxorubicin hydrochloride; droloxifene; droloxifenecitrate; dromostanolone propionate; duazomycin; edatrexate; eflornithinehydrochloride; elsamitrucin; eltrombopag olamine; enloplatin; ENMD-2076;enpromate; epipropidine; epirubicin hydrochloride; epoetin alfa;erbulozole; erlotinib hydrochloride; esorubicin hydrochloride;estramustine; estramustine phosphate sodium; etanidazole; etoposide;etoposide phosphate; etoprine; everolimus; exemestane; fadrozolehydrochloride; fazarabine; fenretinide; filgrastim; floxuridine;fludarabine phosphate; fluorouracil; flurocitabine; foretinib;fosquidone; fostriecin sodium; fulvestrant; gefitinib; gemcitabine;gemcitabine hydrochloride; gemcitabine-cisplatin; gemtuzumab ozogamicin;goserelin acetate; GSK1120212; histrelin acetate; hydroxyurea;idarubicin hydrochloride; ifosfamide; iimofosine; ibritumomab tiuxetan;idarubicin; ifosfamide; imatinib mesylate; imiquimod; interleukin Il(including recombinant interleukin II, or rlL2), interferon alfa-2a;interferon alfa-2b; interferon alfa-n1; interferon alfa-n3; interferonbeta-1 a; interferon gamma-1 b; iproplatin; irinotecan hydrochloride;ixabepilone; lanreotide acetate; lapatinib; lenalidomide; letrozole;leuprolide acetate; leucovorin calcium; leuprolide acetate; levamisole;liposomal cytarabine; liarozole hydrochloride; lometrexol sodium;lomustine; losoxantrone hydrochloride; masoprocol; maytansine;mechlorethamine hydrochloride; megestrol acetate; melengestrol acetate;melphalan; menogaril; mercaptopurine; methotrexate; methotrexate sodium;methoxsalen; metoprine; meturedepa; mitindomide; mitocarcin; mitocromin;mitogillin; mitomalcin; mitomycin C; mitosper; mitotane; mitoxantronehydrochloride; MM-121; mycophenolic acid; nandrolone phenpropionate;nelarabine; nilotinib; nocodazoie; nofetumomab; nogalamycin; ofatumumab;onartuzumab; oprelvekin; ormaplatin; oxaliplatin; oxisuran; paclitaxel;palbociclib (PD-0332991); palifermin; palonosetron hydrochloride;pamidronate; pegfilgrastim; pemetrexed disodium; pentostatin;panitumumab; pazopanib hydrochloride; pemetrexed disodium; plerixafor;pralatrexate; pegaspargase; peliomycin; pentamustine; peplomycinsulfate; perfosfamide; pipobroman; piposulfan; piroxantronehydrochloride; plicamycin; plomestane; porfimer sodium; porfiromycin;prednimustine; procarbazine hydrochloride; puromycin; puromycinhydrochloride; pyrazofurin; quinacrine; raloxifene hydrochloride;rasburicase; recombinant HPV bivalent vaccine; recombinant HPVquadrivalent vaccine; riboprine; rogletimide; rituximab; romidepsin;romiplostim; safingol; safingol hydrochloride; saracatinib;sargramostim; seliciclib; semustine; simtrazene; sipuleucel-T;sorafenib; sparfosate sodium; sparsomycin; spirogermanium hydrochloride;spiromustine; spiroplatin; streptonigrin; streptozocin; sulofenur;sunitinib malate; talisomycin; tamoxifen citrate; tecogalan sodium;TAK-733; tegafur; teloxantrone hydrochloride; temozolomide; temoporfin;temsirolimus; teniposide; teroxirone; testolactone; thalidomide;thiamiprine; thioguanine; thiotepa; tiazofurin; tirapazamine; topotecanhydrochloride; toremifene; tositumomab and I 131 Iodine tositumomab;trastuzumab; trestolone acetate; tretinoin; triciribine phosphate;trimetrexate; trimetrexate glucuronate; triptorelin; tubulozolehydrochloride; U3-1287; uracil mustard; uredepa; valrubicin; vapreotide;verteporfin; vinblastine; vinblastine sulfate; vincristine sulfate;vindesine; vindesine sulfate; vinepidine sulfate; vinglycinate sulfate;vinleurosine sulfate; vinorelbine tartrate; vinrosidine sulfate;vinzolidine sulfate; vorinostat; vorozole; zeniplatin; zinostatin;zoledronic acid; or zorubicin hydrochloride.

In some embodiments, the at least one additional chemotherapeutic agentis selected from, by way of example only, alemtuzumab, arsenic trioxide,asparaginase (pegylated or non-), bevacizumab, cetuximab, platinum-basedcompounds such as cisplatin, cladribine,daunorubicin/doxorubicin/idarubicin, irinotecan, fludarabine,5-fluorouracil, gemtuzumab, methotrexate, taxol, temozolomide,thioguanine, or classes of drugs including hormones (an antiestrogen, anantiandrogen, or gonadotropin releasing hormone analogues, interferonssuch as alpha interferon, nitrogen mustards such as busulfan ormelphalan or mechlorethamine, retinoids such as tretinoin, topoisomeraseinhibitors such as irinotecan or topotecan, tyrosine kinase inhibitorssuch as gefinitinib or imatinib, or agents to treat signs or symptomsinduced by such therapy including allopurinol, filgrastim,granisetron/ondansetron/palonosetron, dronabinol.

In one aspect, the compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered or formulatedin combination with one or more anti-cancer agents. In some embodiments,one or more of the anti-cancer agents are proapoptotic agents. Examplesof anti-cancer agents include, but are not limited to, any of thefollowing: gossypol, genasense, polyphenol E, Chlorofusin, alltrans-retinoic acid (ATRA), bryostatin, tumor necrosis factor-relatedapoptosis-inducing ligand (TRAIL), 5-aza-2′-deoxycytidine, all transretinoic acid, doxorubicin, vincristine, etoposide, gemcitabine,imatinib, geldanamycin, 17-N-Allylamino-17-Demethoxygeldanamycin(17-AAG), flavopiridol, LY294002, bortezomib, trastuzumab, BAY 11-7082,PKC412, or PD184352, paclitaxel, and analogs of paclitaxel. Compoundsthat have the basic taxane skeleton as a common structure feature, havealso been shown to have the ability to arrest cells in the G2-M phasesdue to stabilized microtubules and may be useful for treating cancer incombination with the compounds described herein.

Further examples of anti-cancer agents for use in combination with thecompounds of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, include inhibitors of mitogen-activated proteinkinase signaling, e.g., U0126, PD98059, PD184352, PD0325901,ARRY-142886, SB239063, SP600125, BAY 43-9006, wortmannin, or LY294002;Syk inhibitors; mTOR inhibitors; and antibodies (e.g., rituxan).

Further examples of anti-cancer agents for use in combination with thecompounds of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, include aromatase inhibitors. Aromataseinhibitors include steroidal aromatase inhibitors and non-steroidalaromatase inhibitors. Steroidal aromatase inhibitors include, but arenot limited to, exemestane. Non-steroidal aromatase inhibitors include,but are not limited to, anastrozole, and letrozole. In some embodiments,the aromatase inhibitor is anastrozole, letrozole or exemestane.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith a CDK 4/6 inhibitor. In some embodiments, the CDK 4/6 inhibitor ispalbociclib (PD-0332991), LEE011 or LY283519. In some embodiments, theCDK 4/6 inhibitor is LEE011. In some embodiments, LEE011 is administeredat a dose of about 10 mg per day to about 1000 mg per day. In someembodiments, LEE011 is administered at a dose of about 400 mg per day,about 500 mg per day or about 600 mg per day. In some embodiments, thedaily dose of LEE011 is orally administered. In some embodiments, thedaily dose of LEE011 is orally administered once a day for three weeksfollowed by a one week drug holiday where LEE011 is not administered.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith a phosphoinositide 3-kinase (PI3K)/mTOR pathway inhibitor. In someembodiments, the a phosphoinositide 3-kinase (PI3K)/mTOR pathwayinhibitor is everolimus, temsirolimus, BEZ235, BYL719, GDC0032, BKM120,BGT226, GDC0068, GDC-0980, GDC0941, INK128 (MLN0128), INK1117, OSI-027,CC-223, AZD8055, SAR245408, SAR245409, PF04691502, WYE125132,GSK2126458, GSK-2636771, BAY806946, PF-05212384, SF1126, PX866, AMG319,ZSTK474, Cal101, PWT33597, CU-906, AZD-2014 or CUDC-907. In someembodiments, the phosphoinositide 3-kinase (PI3K)/mTOR pathway inhibitoris everolimus. In some embodiments, everolimus is administered at a doseof about 1 mg per day to about 20 mg per day. In some embodiments,everolimus is administered at a dose of about 2.5 mg per day, about 5 mgper day, or about 10 mg per day. In some embodiments, the daily dose ofeverolimus is administered once a day. In some embodiments, thephosphoinositide 3-kinase (PI3K)/mTOR pathway inhibitor is BKM120. Insome embodiments, BKM120 is administered at a dose of about 5 mg per dayto about 500 mg per day. In some embodiments, BKM120 is administered ata dose of about 50 mg per day to about 100 mg per day. In someembodiments, BKM120 is administered at a dose of about 100 mg per day.In some embodiments, the daily dose of BKM120 is administered once aday. In some embodiments, the phosphoinositide 3-kinase (PI3K)/mTORpathway inhibitor is BYL719. In some embodiments, BYL719 is administeredat a dose of about 25 mg per day to about 1000 mg per day. In someembodiments, BYL719 is administered at a dose of about 250 mg per day orabout 350 mg per day. In some embodiments, the daily dose of BYL719 isadministered once a day.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith a histone deacetylase inhibitor (HDAC). In some embodiments, theHDAC inhibitor is entinostat, vorinostat (SAHA), panobinostat ormocetinostat. In some embodiments, the HDAC inhibitor is entinostat. Insome embodiments, entinostat is administered at a dose of about 0.1 mgper day to about 100 mg per day. In some embodiments, entinostat isadministered at a dose of about 4 mg per day to about 15 mg per day. Insome embodiments, entinostat is administered orally on days 1 and 15 ofa 28 day cycle. In some embodiments, entinostat is administered orallyweekly for 3 weeks followed by a 1-week break in a 4-week cycle. In someembodiments, entinostat is administered orally on days 3 and 10 of a 28day cycle. In some embodiments, entinostat is administered once daily ondays 1, 8, 15, 22, and 29. In some embodiments, 10 mg or 15 mg ofentinostat is administered every other week or 15 mg on days 1, 8, and15 every 28 days. In some embodiments, entinostat is orally administeredon day 1 and day 8 at a dose of between 4 mg to 8 mg. In someembodiments, 5 mg of entinostat is orally administered once weekly.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith a HER-2 inhibitor. In some embodiments, the HER-2 inhibitor istrastuzumab, pertuzumab or TDM-1.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith an epidermal growth factor receptor (EGFR) inhibitor. In someembodiments, the EGFR inhibitor is lapatinib, gefitinib, erlotinib,cetuximab, canertinib, panitumumab, nimotuzumab, OSI-632, vandetanib,afatinib, MP-412, AEE-788, neratinib, XL-647, dacomitinib, AZD-8931,CUDC-101, AP-26113, MEHD7945A or CO-1686.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith an anti-angiogenesis agent. In some embodiments, theanti-angiogenesis agent is a VEGFR inhibitor. In some embodiments, theanti-angiogenesis agent is a multi-kinase targeting agent. In someembodiments, the anti-angiogenesis agent is bevacizumab, ABR-215050(tasquinimod), CHIR-258 (dovitinib), EXEL-7647, OSI-930, BIBF-1120,BAY-73-4506, BMS-582664 (brivanib), RO-4929097, JNJ-26483327, AZD-2171(cediranib), sorafenib, aflibercept, enzastaurin, AG-013736 (axitinib),GSK-786034 (pazopanib), AP-23573, or sunitinib.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith an anti-PD-1 agent. In some embodiments, the anti-PD-1 agent isMK-3475, Nivolumab, MPDL3280A, or MEDI4736.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith an AKT inhibitor. In some embodiments, the AKT inhibitor isGDC0068, MK-2206, AT7867, GSK2110183, GSK2141795, AZD5363 or GSK690693.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith an IGFR inhibitor. In some embodiments, the IGFR inhibitor iscixutumumab, dalotuzumab, BMS-754807, or MEDI-573

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith an FGFR inhibitor. In some embodiments, the FGFR inhibitor isCHIR-258 (dovitinib), E-3810, or AZD4547.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered in combinationwith doxorubicin, cyclophosphamide, capecitabine, vinorelbine,paclitaxel, doxetaxel, or cisplatin.

Yet other anticancer agents for use in combination with the compounds ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, include alkylating agents, antimetabolites, natural products,or hormones, e.g., nitrogen mustards (e.g., mechloroethamine,cyclophosphamide, chlorambucil, etc.), alkyl sulfonates (e.g.,busulfan), nitrosoureas (e.g., carmustine, lomusitne, etc.), ortriazenes (decarbazine, etc.). Examples of antimetabolites include butare not limited to folic acid analog (e.g., methotrexate), or pyrimidineanalogs (e.g., Cytarabine), purine analogs (e.g., mercaptopurine,thioguanine, pentostatin).

Examples of natural products for use in combination with the compoundsof Formula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, include but are not limited to vinca alkaloids (e.g.,vinblastin, vincristine), epipodophyllotoxins (e.g., etoposide),antibiotics (e.g., daunorubicin, doxorubicin, bleomycin), enzymes (e.g.,L-asparaginase), or biological response modifiers (e.g., interferonalpha).

Examples of alkylating agents for use in combination with the compoundsof Formula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, include, but are not limited to, nitrogen mustards (e.g.,mechloroethamine, cyclophosphamide, chlorambucil, meiphalan, etc.),ethylenimine and methylmelamines (e.g., hexamethlymelamine, thiotepa),alkyl sulfonates (e.g., busulfan), nitrosoureas (e.g., carmustine,lomusitne, semustine, streptozocin, etc.), or triazenes (decarbazine,etc.).

In some embodiments, compounds of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, are used to treat cancer incombination with: a second antiestrogen (e.g., tamoxifen), anantiandrogen (e.g., bicalutamide, flutamide, enzalutamide,JNJ56021927/ARN-509), a gonadotropin releasing hormone analog (e.g.,leuprolide).

Other agents that can be used in the methods and compositions describedherein for the treatment or prevention of cancer include platinumcoordination complexes (e.g., cisplatin, carboblatin), anthracenedione(e.g., mitoxantrone), substituted urea (e.g., hydroxyurea), methylhydrazine derivative (e.g., procarbazine), adrenocortical suppressant(e.g., mitotane, aminoglutethimide).

Examples of anti-cancer agents which act by arresting cells in the G2-Mphases due to stabilized microtubules include without limitation thefollowing marketed drugs and drugs in development: Erbulozole,Dolastatin 10, Mivobulin isethionate, Vincristine, NSC-639829,Discodermolide, ABT-751, Altorhyrtins (such as Altorhyrtin A andAltorhyrtin C), Spongistatins (such as Spongistatin 1, Spongistatin 2,Spongistatin 3, Spongistatin 4, Spongistatin 5, Spongistatin 6,Spongistatin 7, Spongistatin 8, and Spongistatin 9), Cemadotinhydrochloride, Epothilones (such as Epothilone A, Epothilone B,Epothilone C, Epothilone D, Epothilone E, Epothilone F, Epothilone BN-oxide, Epothilone A N-oxide, 16-aza-epothilone B, 21-aminoepothiloneB, 21-hydroxyepothilone D, 26-fluoroepothilone, Auristatin PE,Soblidotin, Vincristine sulfate, Cryptophycin 52, Vitilevuamide,Tubulysin A, Canadensol, Centaureidin, Oncocidin A1 Fijianolide B,Laulimalide, Narcosine, Nascapine, Hemiasterlin, Vanadoceneacetylacetonate, Indanocine Eleutherobins (such asDesmethyleleutherobin, Desaetyleleutherobin, lsoeleutherobin A, andZ-Eleutherobin), Caribaeoside, Caribaeolin, Halichondrin B, DiazonamideA, Taccalonolide A, Diozostatin, (−)-Phenylahistin, Myoseverin B,Resverastatin phosphate sodium.

In one aspect, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is co-administered withthrombolytic agents (e.g., alteplase anistreplase, streptokinase,urokinase, or tissue plasminogen activator), heparin, tinzaparin,warfarin, dabigatran (e.g., dabigatran etexilate), factor Xa inhibitors(e.g., fondaparinux, draparinux, rivaroxaban, DX-9065a, otamixaban,LY517717, or YM150), ticlopidine, clopidogrel, CS-747 (prasugrel,LY640315), ximelagatran, or BIBR 1048.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in combination withanti-emetic agents to treat nausea or emesis, which may result from theuse of a compound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, anti-cancer agent(s) and/or radiation therapy.

Anti-emetic agents include, but are not limited to: neurokinin-1receptor antagonists, 5HT3 receptor antagonists (such as ondansetron,granisetron, tropisetron, palonosetron, and zatisetron), GABA_(B)receptor agonists (such as baclofen), corticosteroids (such asdexamethasone, prednisone, prednisolone, or others), dopamineantagonists (such as, but not limited to, domperidone, droperidol,haloperidol, chlorpromazine, promethazine, prochlorperazine,metoclopramide), antihistamines (H1 histamine receptor antagonists, suchas but not limited to, cyclizine, diphenhydramine, dimenhydrinate,meclizine, promethazine, hydroxyzine), cannabinoids (such as but notlimited to, cannabis, marinol, dronabinol), and others (such as, but notlimited to, trimethobenzamide; ginger, emetrol, propofol).

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in combination with anagent useful in the treatment of anemia. Such an anemia treatment agentis, for example, a continuous eythropoiesis receptor activator (such asepoetin-α).

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in combination with anagent useful in the treatment of neutropenia. Examples of agents usefulin the treatment of neutropenia include, but are not limited to, ahematopoietic growth factor which regulates the production and functionof neutrophils such as a human granulocyte colony stimulating factor,(G-CSF). Examples of a G-CSF include filgrastim.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered withcorticosteroids. Corticosteroids, include, but are not limited to:betamethasone, prednisone, alclometasone, aldosterone, amcinonide,beclometasone, betamethasone, budesonide, ciclesonide, clobetasol,clobetasone, clocortolone, cloprednol, cortisone, cortivazol,deflazacort, deoxycorticosterone, desonide, desoximetasone,desoxycortone, dexamethasone, diflorasone, diflucortolone,difluprednate, fluclorolone, fludrocortisone, fludroxycortide,flumetasone, flunisolide, fluocinolone acetonide, fluocinonide,fluocortin, fluocortolone, fluorometholone, fluperolone, fluprednidene,fluticasone, formocortal, halcinonide, halometasone,hydrocortisone/cortisol, hydrocortisone aceponate, hydrocortisonebuteprate, hydrocortisone butyrate, loteprednol, medrysone,meprednisone, methylprednisolone, methylprednisolone aceponate,mometasone furoate, paramethasone, prednicarbate,prednisone/prednisolone, rimexolone, tixocortol, triamcinolone, andulobetasol.

In one embodiment, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is administered to a mammal incombination with a non-steroidal anti-inflammatory drug (NSAID). NSAIDsinclude, but are not limited to: aspirin, salicylic acid, gentisic acid,choline magnesium salicylate, choline salicylate, choline magnesiumsalicylate, choline salicylate, magnesium salicylate, sodium salicylate,diflunisal, carprofen, fenoprofen, fenoprofen calcium, flurobiprofen,ibuprofen, ketoprofen, nabutone, ketolorac, ketorolac tromethamine,naproxen, oxaprozin, diclofenac, etodolac, indomethacin, sulindac,tolmetin, meclofenamate, meclofenamate sodium, mefenamic acid,piroxicam, meloxicam, COX-2 specific inhibitors (such as, but notlimited to, celecoxib, rofecoxib, valdecoxib, parecoxib, etoricoxib,lumiracoxib, CS-502, JTE-522, L-745,337 and NS398).

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is coadministered with ananalgesic.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in combination withradiation therapy (or radiotherapy). Radiation therapy is the treatmentof cancer and other diseases with ionizing radiation. Radiation therapycan be used to treat localized solid tumors, such as cancers of theskin, tongue, larynx, brain, breast, prostate, colon, uterus and/orcervix. It can also be used to treat leukemia and lymphoma (cancers ofthe blood-forming cells and lymphatic system, respectively).

A technique for delivering radiation to cancer cells is to placeradioactive implants directly in a tumor or body cavity. This is calledinternal radiotherapy (brachytherapy, interstitial irradiation, andintracavitary irradiation are types of internal radiotherapy.) Usinginternal radiotherapy, the radiation dose is concentrated in a smallarea, and the patient stays in the hospital for a few days. Internalradiotherapy is frequently used for cancers of the tongue, uterus,prostate, colon, and cervix.

The term “radiotherapy” or “ionizing radiation” include all forms ofradiation, including but not limited to α, β, and γ radiation andultraviolet light.

In some embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used in the treatment ofbreast cancer in combination with at least one additional treatmentoption for the breast cancer. In some embodiments, a compound of Formula(I), (II), or (III), or a pharmaceutically acceptable salt thereof, isused either alone or in combination with other agents used to treatbreast cancer, including but not limited to aromatase inhibitors,anthracylines, platins, nitrogen mustard, alkylating agents, taxanes,nucleoside analogs, a phosphoinositide 3-kinase (PI3K)/mTOR pathwayinhibitor, CDK 4/6 inhibitors, HER-2 inhibitors, EGFR inhibitors, PD-1inhibitors, poly ADP-ribose polymerase (PARP) inhibitors, histonedeacetylase (HDAC) inhibitors, and HSP90 inhibitors. Illustrative agentsused to treat breast cancer, include, but are not limited to,fulvestrant, tamoxifen, anastrozole, letrozole, exemestane, GDC0032,goserelin, leuprolide, raloxifene, toremifene, megestrol acetate,bazedoxifene, cisplatin, carboplatin, capecitabine, cyclophosphamide,docetaxel, doxorubicin, epirubicin, eribulin, filgrastim, fluorouracil,gemcitabine, ixabepilone, LEE011, LY2835219, mitoxantrone, methotrexate,paclitaxel, pamidronate, vinorelbine, pegfilgrastim, pertuzumab,trastuzumab, lapatinib, everolimus, bevacizumab, temsirolimus andcombinations thereof, as well as others described herein. Additionalnon-limiting exemplary agents for the treatment of breast cancer areprovided elsewhere herein. In some embodiments, a compound of Formula(I), (II), or (III), or a pharmaceutically acceptable salt thereof, isused either alone or in combination with breast cancer surgery. In someembodiments, breast cancer surgery comprises lumpectomy, mastectomy,sentinel node biopsy, or axillary node dissection. In some embodiments,a compound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, is used either alone or in combination withradiation therapy. In some embodiments, radiation comprises externalbeam radiation or brachytherapy. In some embodiments, a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, is used either alone or in combination with hormone therapy(i.e. hormone blocking therapy). In some embodiments, hormone therapycomprises the use of a selective estrogen receptor modulator (e.g.tamoxifen), aromatase inhibitor, or fulvestrant. In some embodiments, acompound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, is used either alone or in combination withsurgery to remove the ovaries or medications to stop the ovaries frommaking estrogen. In some embodiments, a compound of Formula (I), (II),or (III), or a pharmaceutically acceptable salt thereof, is used eitheralone or in combination with trastuzumab, lapatinib, or bevacizumab. Insome embodiments, a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, is used either alone or incombination with bone-building drugs to prevent breast cancer recurrence(e.g. zoledronic acid (Reclast, Zometa)).

Kits/Articles of Manufacture

For use in the therapeutic applications described herein, kits andarticles of manufacture are also described herein. Such kits cancomprise a carrier, package, or container that is compartmentalized toreceive one or more containers such as vials, tubes, and the like, eachof the container(s) comprising one of the separate elements to be usedin a method described herein. Suitable containers include, for example,bottles, vials, syringes, and test tubes. The containers are formed fromany acceptable material including, e.g., glass or plastic.

For example, the container(s) can comprise one or more compoundsdescribed herein, optionally in a composition or in combination withanother agent as disclosed herein. The container(s) optionally have asterile access port (for example the container can be an intravenoussolution bag or a vial having a stopper pierceable by a hypodermicinjection needle). Such kits optionally comprising a compound with anidentifying description or label or instructions relating to its use inthe methods described herein.

A kit will typically comprise one or more additional containers, eachwith one or more of various materials (such as reagents, optionally inconcentrated form, and/or devices) desirable from a commercial and userstandpoint for use of a compound described herein. Non-limiting examplesof such materials include, but not limited to, buffers, diluents,filters, needles, syringes; carrier, package, container, vial and/ortube labels listing contents and/or instructions for use, and packageinserts with instructions for use. A set of instructions will alsotypically be included.

A label can be on or associated with the container. A label can be on acontainer when letters, numbers or other characters forming the labelare attached, molded or etched into the container itself, a label can beassociated with a container when it is present within a receptacle orcarrier that also holds the container, e.g., as a package insert. Alabel can be used to indicate that the contents are to be used for aspecific therapeutic application. The label can also indicate directionsfor use of the contents, such as in the methods described herein.

EXAMPLES

These examples are provided for illustrative purposes only and not tolimit the scope of the claims provided herein.

Intermediate 1 N,2,5-Trimethoxy-N-methylbenzamide

Oxalyl chloride (3.6 mL, 41.3 mmol) was added to a solution of2,5-dimethoxybenzoic acid (6.00 g, 33.0 mmol) in DCM (100 mL) at roomtemperature. Then, DMF (0.2 mL) was added to the mixture. The resultingsolution was stirred at room temperature for 2 h, and the solvent wasremoved on a rotary evaporator. The crude material was placed undervacuum for 30 minutes to remove the residual oxalyl chloride to give thecrude acid chloride. Crude material was dissolved in DCM (100 mL) andcooled to 0° C. To this solution, N, O-dimethylhydroxylaminehydrochloride (4.03 g, 41.32 mmol) and triethylamine (6.8 mL, 48.78mmol) were added. The resulting mixture was stirred at 0° C. for 30 minand then at room temperature for additional 30 min. The reaction wasdiluted with DCM (50 mL), washed with H₂O (2×100 mL), washed with brine(100 mL), dried over Na₂SO₄, filtered, and concentrated on a rotaryevaporator. The crude material was purified by silica gel chromatographyto yield N,2,5-trimethoxy-N-methylbenzamide (7.32 g, 99%) as clear oilwhich solidified over time. ¹H NMR (CDCl₃): δ 7.90 (m, 3H), 3.82 (s,3H), 3.79 (s, 3H), 3.58 (br s, 3H), 3.32 (br s, 3H).

Intermediate 21-(2-Hydroxy-5-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)ethanone

Step 1: 1-(2, 5-Dimethoxyphenyl)-2-(3-methoxyphenyl)ethanone

A 5 mL portion of 3-methoxybenzyl chloride (12.8 mL, 88.1 mmol) in THF(60 mL) was added to a mixture of magnesium (2.88 g, 118 mmol) andiodine (1 crystal) in THF (30 mL). The reaction mixture was stirreduntil the color disappeared and the remaining solution of3-methoxybenzyl chloride was added dropwise over 45 min. The mixture washeated at 60° C. for 1 h and then cooled to 0° C. A solution ofIntermediate 1 (6.65 g 29.6 mmol) in THF (70 mL) was added to thismixture over 30 min at 0° C. The reaction was stirred for 30 min at 0°C. and quenched with brine (50 mL). The mixture was extracted with ethylacetate (3×100 mL). The combined organic extracts were washed with brine(50 mL), dried over Na₂SO₄, filtered, and concentrated on a rotaryevaporator to give 1-(2,5-dimethoxyphenyl)-2-(3-methoxyphenyl)ethanone(7.99 g, 95%) as a white solid. ¹H NMR (CDCl₃): δ 7.25 (m, 2H), 7.01(dd, 1H), 6.92 (d, 1H), 6.83 (m, 3H), 4.30 (s, 2H), 3.90 (s, 3H), 3.82(s, 3H), 3.79 (s, 3H).

Step 2: 1-(2,5-Dihydroxyphenyl)-2-(3-hydroxyphenyl)ethanone

To a solution of 1-(2,5-dimethoxyphenyl)-2-(3-methoxyphenyl)ethanone(3.35 g, 11.7 mmol) in DCM (50 mL) at −78° C., boron tribromide (1M inDCM, 48.0 mL, 48.0 mmol) was added dropwise. The reaction mixture waswarmed to 0° C., stirred for 30 min, re-cooled to −78° C., and thenquenched with methanol (15 mL). The reaction mixture was warmed to roomtemperature, concentrated on a rotary evaporator and purified by silicagel chromatography to give1-(2,5-dihydroxyphenyl)-2-(3-hydroxyphenyl)ethanone (1.78 g, 62%) as ayellow solid. ¹H NMR (DMSO-d₆): δ 11.24 (s, 1H), 9.34 (s, 1H), 9.20 (s,1H), 7.26 (m, 1H), 7.10 (t, 1H), 6.98 (dd, 1H), 6.83 (d, 1H), 6.70 (m,3H), 4.24 (s, 2H).

Step 3:1-(2-Hydroxy-5-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)ethanone

3,4-Dihydro-2H-pyran (2.65 g, 30.8 mmol) in DCM (6 mL) was added to amixture of 1-(2,5-dihydroxyphenyl)-2-(3-hydroxyphenyl)ethanone (1.50 g,6.15 mmol) and pyridinium p-toluene sulfonate (320 mg, 1.27 mmol) in DCM(40 mL). The reaction mixture was stirred at room temperature for 1 hand diluted with DCM (100 mL). The solution was washed with sat'd NaHCO₃(2×50 mL), washed with brine (50 mL), dried over Na₂SO₄, filtered, andconcentrated on a rotary evaporator. The crude material was purified bysilica gel chromatography to give1-(2-hydroxy-5-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)ethanone(2.42 g, 96%) as yellow oil which solidified over time. ¹H NMR (CDCl₃):δ 11.88 (s, 1H), 7.60 (m, 1H), 7.30 (m, 2H), 7.00 (m, 2H), 6.92 (m, 2H),5.42 (m, 1H), 5.28 (m, 1H), 4.25 (s, 2H), 3.92 (m, 2H), 3.62 (m, 2H),1.55-2.07 (m, 12H).

Intermediate 32-(4-Iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromene

Step 1:2-(4-Iodophenyl)-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-one

A solution of Intermediate 2 (2.41 g, 5.84 mmol), 4-iodobenzaldehyde(1.37 g, 5.91 mmol), piperidine (166 mg, 1.95 mmol), and DBU (301 mg,1.98 mmol) in s-butanol (10 mL) was heated at reflux. Using a Dean-Starktrap, half (5 mL) of the solvent was collected over 45 min, and thereaction was kept at reflux without further concentration for additional45 min. The reaction mixture was cooled to 90° C., i-propanol (10 mL)was added, and the reaction was allowed to cool to room temperature andstirred overnight. The resulting precipitate was collected by filtrationto yield2-(4-iodophenyl)-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-one(3.17 g, 87%) as a white solid. ¹H NMR (DMSO-d₆): δ 7.63 (d, 2H), 7.42(m, 1H), 7.33 (m, 1H), 7.21 (d, 2H), 7.07 (m, 2H), 6.79 (m, 3H), 5.88(m, 1H), 5.48 (m, 1H), 5.31 (m, 1H), 4.60 (d, 1H), 3.40-3.80 (m, 4H),1.55-1.90 (m, 12H).

Step 2: 3-(3-Hydroxyphenyl)-2-(4-iodophenyl)-4-methyl-2H-chromen-6-ol

Methyl magnesium chloride (3M in THF, 4.0 mL, 12 mmol) was addeddropwise to a solution of2-(4-iodophenyl)-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-one(1.99 g, 3.18 mmol) in THF (40 mL) at 0° C. The reaction was stirred at0° C. for 15 min and allowed to warm to room temperature. After stirringfor 2 h, the solution was cooled to 0° C., quenched with sat'd ammoniumchloride, and then allowed to warm to room temperature. Ethyl acetate(100 mL) and H₂O (50 mL) were added, and the layers were separated. Theorganic layer was dried over Na₂SO₄, concentrated on a rotaryevaporator, and purified by silica gel chromatography to yield a whitefoam (1.75 g). This purified material was heated in 80% acetic acid/H₂O(50 mL) overnight at 90° C. The solution was diluted with ethyl acetate(100 mL), washed with H₂O (50 mL), washed with sat'd NaHCO₃ (50 mL),washed with brine (50 mL), and dried over Na₂SO₄, filtered, andconcentrated on a rotary evaporator. The crude material was purified bysilica gel chromatography to give3-(3-hydroxyphenyl)-2-(4-iodophenyl)-4-methyl-2H-chromen-6-ol (0.99 g,68%) as a beige solid. ¹H NMR (DMSO-d₆): δ 9.46 (s, 1H), 9.00 (s, 1H),7.62 (d, 2H), 7.17 (t, 1H), 7.01 (d, 2H), 6.70 (m, 4H), 6.51 (s, 2H),5.90 (s, 1H), 2.03 (s, 3H).

Step 3:2-(4-Iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromene

3,4-Dihydro-2H-pyran (1.1 mL, 12 mmol) was added to a solution of3-(3-hydroxyphenyl)-2-(4-iodophenyl)-4-methyl-2H-chromen-6-ol (990 mg,2.19 mmol) and pyridinium p-toluene sulfonate (115 mg, 0.458 mmol) inDCM (30 mL). The reaction was stirred at room temperature for 3 h,diluted with DCM (100 mL), washed with sat'd NaHCO₃ (100 mL), washedwith H₂O (2×50 mL), washed with brine (50 mL), dried over Na₂SO₄,filtered, and concentrated on a rotary evaporator. The crude materialwas purified by silica gel chromatography to give2-(4-iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromene(1.30 g, 95%) as a white foam. ¹H NMR (DMSO-d₆): δ7.62 (d, 2H), 7.27 (t,1H), 7.10 (d, 2H), 6.92 (m, 4H), 6.81 (d, 1H), 6.63 (d, 1H), 6.04 (d,1H), 5.43 (m, 1H), 5.36 (s, 1H), 3.75 (m, 2H), 3.55 (m, 2H), 2.05 (s,3H), 1.50-1.99 (m, 12H).

Large Scale Synthesis of Intermediate 32-(4-Iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromene

Step 1: 2-(3-Methoxyphenyl)acetyl chloride

Thionyl chloride (1 L) was added over 30 min to a suspension of2-(3-methoxyphenyl)acetic acid (530 g, 3.19 mol) and dry dichloromethane(3 L) in an ice bath. N,N-Dimethylformamide (15 mL) was added dropwiseover 10 min keeping the internal temperature below 20° C. The ice bathwas removed, and the reaction mixture was stirred until gas evolutionhas ceased. The mixture was heated at reflux (˜50° C.) for 3 h, stirredat room temperature overnight, and then concentrated to give a yellowoil which was used directly in the next step.

Step 2: 1-(2,5-Dimethoxyphenyl)-2-(3-methoxyphenyl)ethanone

1,4-Dimethoxybenzene (400 g, 3.19 mol) was added to a suspension ofAlCl₃ (400 g, 3.5 mol) and dry dichloromethane (10 L) in an ice/dry icebath. A solution of 2-(3-methoxyphenyl)acetyl chloride (606 g, 3.19 mol)in dichloromethane (1 L) was added dropwise over 3 h keeping theinternal temperature below 0° C. The resulting mixture was stirred at 0°C. for 1 h, poured into ice water (5 L) over 30 min with stirring(exothermic), and then extracted with dichloromethane (5 L×2). Thecombined organic layers were washed with 1 N aqueous HCl (2 L),saturated aqueous NaHCO₃ (2 L), and then brine (2 L). The resultingsolution was dried (MgSO₄), concentrated, and purified by silica gelchromatography [petroleum ether (bp: 60-90° C.)/EtOAc-5:1] to give1-(2,5-dimethoxyphenyl)-2-(3-methoxyphenyl)ethanone (500 g). ¹H NMR(DMSO-d₆, 300 MHz): δ 7.19 (dd, 1H), 7.05-7.10 (m, 3H), 6.74-6.79 (m,3H), 4.22 (s, 2H), 3.85 (s, 3H), 3.71 (s, 6H).

Step 3: 1-(2,5-Dihydroxyphenyl)-2-(3-hydroxyphenyl)ethanone

Boron tribromide (332 mL, 3.5 mol) was added dropwise (internaltemperature <−60° C.) to a solution of1-(2,5-dimethoxyphenyl)-2-(3-methoxyphenyl)ethanone (264 g, 0.92 mol) indry dichloromethane (1 L) at −78° C. The mixture was stirred at −78° C.for 30 min, warmed to 0° C. over 30 min, and then stirred at 0° C. foran additional hour. Methanol (100 mL) and then water (100 mL) were addeddropwise keeping the internal temperature below 20° C., and the mixturewas stirred at room temperature for 1 h. The resulting precipitate wascollected by filtration, washed with water (500 mL), and dried to afford1-(2,5-dihydroxyphenyl)-2-(3-hydroxyphenyl)ethanone (125 g). ¹H NMR(DMSO-d₆, 300 MHz): δ 11.50 (br, 1H), 9.29 (br, 2H), 7.27 (d, 1H), 7.10(t, 1H), 6.99 (dd, 1H), 6.81 (d, 1H), 6.70-6.62 (m, 3H), 4.24 (s, 2H).LCMS: 243.0 [M−H]⁻.

Step 4:1-(2-Hydroxy-5-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)ethanone

Pyridinium p-toluenesulfonate (53.6 g, 0.2 mol) was added over 1 h to asolution of 1-(2,5-dihydroxyphenyl)-2-(3-hydroxyphenyl)ethanone (280 g,1.06 mol), 3,4-dihydro-2H-pyran (628 g, 7.48 mol), and dichloromethane(2.5 L) at 5-8° C. The mixture was stirred at rt for 4 h, concentrated,and then purified by silica gel chromatography [petroleum ether (bp:60-90° C.)/EtOAc-10:1] to give1-(2-hydroxy-5-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)ethanone(305 g). ¹H NMR (DMSO-d₆, 300 MHz): δ 11.37 (s, 1H), 7.58 (d, 1H),7.19-7.27 (m, 2H), 6.87-6.94 (m, 4H), 5.39-5.42 (m, 2H), 4.37 (s, 2H),3.75-3.79 (m, 2H), 3.51-3.56 (m, 2H), 1.46-1.85 (m, 12H); LCMS: 413.2[M+H]⁺.

Step 5:2-(4-Iodophenyl)-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-one

1,8-Diazabicycloundec-7-ene (54.3 g, 0.32 mol), 4-iodobenzaldehyde (264g, 1.09 mol), and piperidine (30.3 g, 0.32 mol) were added to a solutionof1-(2-hydroxy-5-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)ethanone(446 g, 1.08 mol) in n-BuOH (600 mL). The mixture was heated at 120° C.for 6 h, stirred at rt for 2 d, and then concentrated. Petroleum ether(2 L) was added to the residue, the mixture was stirred for 30 min, andthe resulting precipitate was collected by filtration to give2-(4-iodophenyl)-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-one(400 g). The filtrate was concentrated and purified by silica gelchromatography [petroleum ether (bp: 60-90° C.)/EtOAc-20:1] to give anadditional 110 g. ¹H NMR (DMSO-d₆, 300 MHz): δ 7.62 (d, 2H), 7.41-7.43(m, 1H), 7.32-7.33 (m, 1H), 7.05-7.30 (m, 4H), 6.71-6.81 (m, 3H),5.83-5.87 (m, 1H), 5.46-5.48 (m, 1H), 5.30-5.32 (m, 1H), 4.58 (d, 1H),3.51-3.75 (m, 4H), 1.51-1.85 (m, 12H).

Step 6:2-(4-Iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-ol

Methylmagnesium chloride (3 M in THF, 485 mL, 1.42 mol) was added over 1h (internal temperature <0° C.) to a solution of2-(4-iodophenyl)-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-one(230 g, 0.367 mol) and dry tetrahydrofuran (1 L) in an ice/dry ice bathunder N₂. The mixture was stirred at 0° C. for 30 min, stirred at roomtemperature for 4 h, and then re-cooled in an ice bath. Saturatedaqueous NH₄Cl (300 mL) was added over 30 min, and the mixture wasextracted with EtOAc (300 mL×3). The combined organic layers were dried(MgSO₄), concentrated, and then purified by silica gel chromatography[petroleum ether (bp: 60-90° C.)/EtOAc-20:1] to give2-(4-iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-ol(230 g). LCMS: 643.0 [M+H]⁺.

Step 7: 3-(3-Hydroxyphenyl)-2-(4-iodophenyl)-4-methyl-2H-chromen-6-ol

Acetic acid (3.2 L) was added to a suspension of2-(4-iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)chroman-4-ol(200 g, 0.31 mol) in water (0.8 L). The reaction mixture was heated at90° C. for 48 h and then concentrated to remove most of the AcOH. Theaqueous residue was extracted with EtOAc (1 L×2). The combined organiclayers were washed with saturated aqueous NaHCO₃ (500 mL), washed withbrine (500 mL), dried (Na₂SO₄), concentrated, and then purified bysilica gel chromatography [petroleum ether (bp: 60-90° C.)/EtOAc-4:1] toafford 3-(3-hydroxyphenyl)-2-(4-iodophenyl)-4-methyl-2H-chromen-6-ol (95g). ¹H NMR (DMSO-d₆, 400 MHz): δ 9.46 (s, 1H), 8.99 (s, 1H), 7.61 (d,2H), 7.14 (t, 1H), 7.08 (d, 2H), 6.75-6.62 (m, 4H), 6.51 (s, 2H), 5.90(s, 1H), 2.03 (s, 3H). LCMS: 455.0 [M−H]⁻.

Step 8:2-(4-Iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromene

Pyridinium p-toluenesulfonate (32 g, 0.13 mol) was added over 10 min(5-8° C.) to a solution of3-(3-hydroxyphenyl)-2-(4-iodophenyl)-4-methyl-2H-chromen-6-ol (150 g,0.42 mol), 3,4-dihydro-2H-pyran (218 g, 2.53 mol), and dichloromethane(3.5 L) in an ice bath. The resulting mixture was stirred at rt for 2 h,concentrated, and purified by silica gel chromatography [petroleum ether(bp: 60-90° C.)/EtOAc-40:1→20:1] to give2-(4-iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromene(145 g). ¹H NMR (DMSO-d₆, 400 MHz): δ 7.62 (dd, 2H), 7.27 (t, 1H), 7.10(d, 2H), 7.00 (t, 1H), 6.90-6.94 (m, 3H), 6.80 (dd, 1H), 6.64 (dd, 1H),6.04 (d, 1H), 5.39-5.45 (m, 1H), 5.35 (t, 1H), 3.70-3.81 (m, 2H),3.50-3.58 (m, 2H), 3.70-3.81 (m, 2H), 2.06 (s, 3H), 1.52-1.87 (m, 10H).

Intermediate 42-(4-(4-Methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethanol

A mixture of Intermediate 3 (1.0 g, 1.6 mmol), ethane-1,2-diol (0.49 g,8.0 mmol), copper iodide (0.03 g, 0.16 mmol), 1,10-phenanthroline (0.058g, 0.32 mmol), potassium carbonate (0.44 g, 3.2 mmol) in butyronitrile(3.2 mL) was degassed with three vacuum/nitrogen cycles. The reactionmixture was heated at 125° C. for 2 days, allowed to cool to roomtemperature, and diluted with ethyl acetate. This mixture was filteredthrough Celite. The organic phase was washed with water, washed withbrine, dried over Na₂SO₄, filtered, and concentrated to afford the crudeproduct. This crude product was then purified by silica gelchromatography to give2-(4-(4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethanol.¹H NMR (DMSO-d₆): δ 7.27-7.13 (m, 3H), 6.98 (t, 1H), 6.93-6.84 (m, 3H),6.80-6.76 (m, 3H), 6.59 (d, 1H), 5.97 (d, 1H), 5.43 (dt, 1H), 5.34 (br,1H), 4.79 (t, 1H), 3.88 (t, 2H), 3.80-3.70 (m, 2H), 3.64 (q, 2H),3.54-3.50 (m, 2H), 2.06 (s, 3H), 1.86-1.66 (m, 6H), 1.59-1.51 (m, 6H).

Intermediate 52-(4-(4-Methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethylmethanesulfonate

To a solution of Intermediate 4 (0.7 g, 1.25 mmol) in DCM (25 mL) at 0°C., triethylamine (0.26 mL, 1.87 mmol) and methanesulfonyl chloride(0.146 mL, 1.87 mmol) were added sequentially. The reaction mixture wasstirred at 0° C. for 1 h, and then diluted with DCM. To this mixture,water (20 mL), and sat'd ammonium chloride (20 mL) were added. Thelayers were separated and the organic layer was washed with water,washed with sat'd NaHCO₃, washed with brine, dried over Na₂SO₄, andconcentrated to give2-(4-(4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethylmethanesulfonate (0.7 g). ¹H NMR (DMSO-d₆): δ 7.25 (d, 3H), 6.99-6.98(m, 1H), 6.93-6.87 (m, 3H), 6.85-6.78 (m, 2H), 6.77-6.75 (dd, 1H), 6.61(d, 1H), 5.98 (d, 1H), 5.43 (d, 1H), 5.34 (br, 1H), 4.47-4.45 (m, 2H),4.16 (br, 2H), 3.83-3.70 (m, 2H), 3.56-3.47 (m, 2H), 3.18 (s, 3H), 2.05(s, 3H), 1.92-1.65 (m, 6H), 1.60-1.40 (m, 6H).

Intermediate 6 2-(3-(Fluoromethyl)azetidin-1-yl)ethanol

Step 1: tert-butyl3-(((methylsulfonyl)oxy)methyl)azetidine-1-carboxylate

Methanesulfonyl chloride (32 mL, 401 mmol) was added over 30 min to asolution of tert-butyl 3-(hydroxymethyl)azetidine-1-carboxylate (50 g,267 mmol), triethylamine (74 mL, 534 mmol), and dichloromethane (500 mL)at 0° C. The resulting cloudy orange mixture was stirred at 0° C. for 1h and then diluted with 10% aqueous citric acid (200 mL). The layerswere separated, and the organic phase was washed with 10% aqueous citricacid (200 mL), sat'd sodium bicarbonate (200 mL×2), and then water (100mL). The organic phase was dried over sodium sulfate, filtered, andconcentrated to give tert-butyl3-(((methylsulfonyl)oxy)methyl)azetidine-1-carboxylate as a dark orangeoil. This material was used without further purification. ¹H NMR (400MHz, DMSO-d₆) δ 4.33 (d, 2H), 3.91 (m, 2H), 3.61 (m, 2H), 3.21 (s, 3H),2.89 (m, 1H), 1.37 (s, 9H).

Step 2: tert-butyl 3-(fluoromethyl)azetidine-1-carboxylate

tert-Butyl 3-(((methylsulfonyl)oxy)methyl)azetidine-1-carboxylate (70 g,267 mmol) was dissolved in a solution of TBAF (1M in THF, 500 mL, 500mmol). The resulting orange solution was refluxed for 1 h and thencooled to rt. Half of the solvent was removed on a rotary evaporator.The resulting thick oil was diluted with ethyl acetate (300 mL) and thenwashed with brine (200 mL×2). The combined brine layers were extractedwith ethyl acetate (200 mL). The organics were combined and washed withwater (200 mL). This aqueous phase was extracted with ethyl acetate (150mL×3). The organics were combined, dried over sodium sulfate, filtered,concentrated, and purified by silica gel chromatography (0-40% ethylacetate/hexanes) to give 42 g of tert-butyl3-(fluoromethyl)azetidine-1-carboxylate as a yellow oil. ¹H NMR (400MHz, DMSO-d₆) δ 4.52 (dd, 2H), 3.90 (m, 2H), 3.61 (m, 2H), 2.83 (m, 1H),1.37 (s, 9H).

Step 3: 3-(Fluoromethyl)azetidine hydrochloride

Aqueous HCl (6M, 111 mL, 666 mmol) was added slowly to a solution oftert-butyl 3-(fluoromethyl)azetidine-1-carboxylate (42 g, 222 mmol) andmethanol (450 mL) at 0° C. The reaction was stirred overnight (warmingto rt as the bath expired) and then concentrated. Residual water wasazeotropically removed with methanol (400 mL×3) on a rotary evaporatoruntil thick oil was obtained. This oil solidified under high vacuum togive 27 g of 3-(fluoromethyl)azetidine hydrochloride as a hygroscopicwhite solid. ¹H NMR (400 MHz, DMSO-d₆) δ 9.18 (bs, 2H), 4.56 (dd, 2H),3.98 (m, 2H), 3.75 (m, 2H), 3.11 (m, 1H).

Step 4: 2-(3-(Fluoromethyl)azetidin-1-yl)ethanol

Aqueous NaOH (5M, 102 mL, 510 mmol) was added to a mixture of3-(fluoromethyl)azetidine hydrochloride (20.0 g, 159 mmol) and THF (640mL) at rt. After stirring for 10 min, 2-bromoethanol (12.4 mL, 175 mmol)was added dropwise. The resulting mixture was stirred overnight, andthen the layers were separated. The organic layer was washed with sat'daqueous K₂CO₃ (200 mL), dried over sodium sulfate, filtered, andconcentrated to give a pale yellow oil. Distillation under reducedpressure (bp: 68-71° C. at 2 torr) gave2-(3-(fluoromethyl)azetidin-1-yl)ethanol as a clear oil. ¹H NMR(DMSO-d₆): δ 4.48 (dd, 2H), 4.35 (t, 1H), 3.31-3.30 (m, 2H), 3.23 (dt,2H), 2.90 (t, 2H), 2.75-2.62 (m, 1H), 2.40 (t, 2H).

Note: 2-(3-(Fluoromethyl)azetidin-1-yl)ethanol can also be purified bysilica gel chromatography [ethyl acetate/hexanes (10:7)→ethylacetate/hexanes/methanol/triethylamine (10:7:2:1)].

Intermediate 7 2-(3-Methylazetidin-1-yl)ethanol

A mixture of 3-methylazetidine hydrochloride (2.5 g, 23.2 mmol),2-bromoethanol (5.80 g, 46.4 mmol) and1,8-diazabicyclo[5.4.0]undec-7-ene (10.61 g, 69.7 mmol) in anhydrous THE(46 mL) was stirred at room temperature for 40 hours. Resulting solidswere filtered off and the filtrate was concentrated on a rotaryevaporator to give a residue that was purified on a silica gel columneluted with hexanes:ethyl acetate:methanol:TEA=10:7:2:1 to afford paleyellow oil. ¹H NMR (400 MHz, DMSO-d₆): δ 4.32 (br, 1H), 3.33-3.26 (m,4H), 2.62 (t, 2H), 2.42-2.34 (m, 1H), 2.37 (t, 2H), 1.07 (d, 3H).

Example 1(±)-2-(4-(2-(3-(Fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-ol

Step 1:(±)-3-(Fluoromethyl)-1-(2-(4-(4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethyl)azetidine

A mixture of Intermediate 3 (30.0 g, 48.0 mmol), Intermediate 6 (9.6 g,72.1 mmol), copper iodide (1.83 g, 9.6 mmol), and potassium carbonate(13.3 g, 96.1 mmol) in butyronitrile (95 mL) was degassed with threevacuum/nitrogen cycles. The reaction mixture was heated at 135° C. for 3days, allowed to cool to room temperature, and diluted with ethylacetate. The reaction mixture was filtered through Celite, and theCelite was washed with ethyl acetate. The filtrate was washed threetimes with water, washed with brine, dried over Na₂SO₄, filtered, andconcentrated under reduced pressure. The crude material was purified bysilica gel chromatography (0-100% EtOAc/hexane) to give(±)-3-(fluoromethyl)-1-(2-(4-(4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethyl)azetidine(25.0 g, 82%) as a beige foam. ¹H NMR (400 MHz, DMSO-d₆): δ 7.27-7.19(m, 3H), 6.98 (t, 1H), 6.93-6.88 (m, 3H), 6.79-6.75 (m, 3H), 6.59 (d,1H), 5.97 (d, 1H), 5.44-5.38 (dt, 1H), 5.34 (m, 1H), 4.47 (dd, 2H),3.87-3.68 (m, 4H), 3.54-3.46 (m, 2H), 3.26 (t, 2H), 2.94 (t, 2H),2.75-2.56 (m, 3H), 2.06 (s, 3H), 1.95-1.45 (m, 12H); LCMS: 630.1 (M+H)⁺.

Note:(±)-3-(fluoromethyl)-1-(2-(4-(4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethyl)azetidinehas also been prepared from Intermediate 5, 3-(fluoromethyl)azetidinehydrochloride, and potassium carbonate in acetonitrile at 80° C.

Step 2:(±)-2-(4-(2-(3-(Fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-ol

(±)-3-(Fluoromethyl)-1-(2-(4-(4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethyl)azetidine(25.8 g, 41.0 mmol) was stirred in 80% acetic acid/H₂O (200.0 mL) atroom temperature for 2 days. The solvents were removed on a rotaryevaporator, and the residue was dissolved in ethyl acetate. The organiclayer was washed with sat'd NaHCO₃, washed with water, washed withbrine, dried over Na₂SO₄, filtered, and concentrated under reducedpressure. This crude material was then purified by silica gelchromatography (0-5% MeOH/DCM) to afford(±)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-ol(16.1 g, 85%) as beige foam. ¹H NMR (DMSO-d₆): δ 9.43 (s, 1H), 8.94 (s,1H), 7.18 (d, 2H), 7.12 (t, 1H), 6.76-6.72 (m, 3H), 6.69-6.60 (m, 2H),6.60 (m, 1H), 6.47 (m, 2H), 5.82 (s, 1H), 4.47 (dd, 2H), 3.81 (t, 2H),3.26 (t, 2H), 2.95 (t, 2H), 2.73-2.60 (m, 3H), 2.02 (s, 3H); LCMS: 462.0(M+H)⁺.

Example 2(R)-2-(4-(2-(3-(Fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-ol

The title compound was the 1^(st) eluting enantiomer when Example 1 wasseparated on a RegisCell column [CO₂/methanol+0.5% diethylamine (75/25,also 72/28), also CO₂/ethanol+0.5% diethylamine (73/27)]. Enantiomericratio: 99:1. ¹H NMR (DMSO-d₆): δ 9.43 (s, 1H), 8.94 (s, 1H), 7.18 (d,2H), 7.12 (t, 1H), 6.76-6.72 (m, 3H), 6.69-6.60 (m, 2H), 6.60 (m, 1H),6.47 (m, 2H), 5.82 (s, 1H), 4.47 (dd, 2H), 3.81 (t, 2H), 3.26 (t, 2H),2.95 (t, 2H), 2.73-2.60 (m, 3H), 2.02 (s, 3H); LCMS: 462.0 (M+H)⁺.

(R)-2-(4-(2-(3-(Fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-olhydrochloride

A solution of hydrochloric acid in diethyl ether (10.7 mL, 2M, 21.4mmol) was added to a solution of(R)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-ol(6.6 g, 14.3 mmol) in ethyl acetate at 0° C. The resulting precipitatewas allowed to stir at 0° C. for 10 minutes. Then, this mixture wasconcentrated down on a rotary evaporator, keeping the bath temperaturearound 0° C. to afford (R)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-olhydrochloride as a pale yellow solid. This solid was further dried underreduced pressure for 2 days (6.2 g). ¹H NMR (DMSO-d₆): δ 10.55 (s, 1H),9.48 (s, 1H), 8.98 (s, 1H), 7.23 (d, 2H), 7.12 (t, 1H), 6.83 (d, 2H),6.74 (d, 1H), 6.68-6.62 (m, 3H), 6.50-6.44 (m, 2H), 5.86 (s, 1H),4.72-4.46 (m, 2H), 4.17-4.12 (m, 4H), 3.99-3.94 (m, 2H), 3.56-3.49 (m,2H), 3.15-3.05 (m, 1H), 2.03 (s, 3H); LCMS: 462.1 (M+H)⁺.

Example 3(S)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-ol

The title compound was the 2^(nd) eluting enantiomer when Example 1 wasseparated on a RegisCell column [CO₂/methanol+0.5% diethylamine (75/25,also 72/28), also CO₂/ethanol+0.5% diethylamine (73/27)]. Enantiomericratio: 99:1. ¹H NMR (DMSO-d₆): δ 9.43 (s, 1H), 8.94 (s, 1H), 7.18 (d,2H), 7.12 (t, 1H), 6.76-6.72 (m, 3H), 6.69-6.60 (m, 2H), 6.60 (m, 1H),6.47 (m, 2H), 5.82 (s, 1H), 4.47 (dd, 2H), 3.81 (t, 2H), 3.26 (t, 2H),2.95 (t, 2H), 2.73-2.60 (m, 3H), 2.02 (s, 3H); LCMS: 462.0 (M+H)⁺.

(S)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-olhydrochloride

A solution of hydrochloric acid in diethyl ether (10.7 mL, 2M, 21.4mmol) was added to a solution of(S)-2-(4-(2-(3-(fluoromethyl)azetidin-1-yl)ethoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-ol(6.6 g, 14.3 mmol) in ethyl acetate at 0° C. The resulting precipitatewas allowed to stir at 0° C. for 10 minutes. Then, this mixture wasconcentrated down on a rotary evaporator, keeping the bath temperaturearound 0° C. to afford a pale yellow solid. This solid was further driedunder reduced pressure for 2 days (6.23 g). ¹H NMR (DMSO-d₆): δ 10.51(s, 1H), 9.48 (s, 1H), 8.98 (s, 1H), 7.23 (d, 2H), 7.12 (t, 1H), 6.83(d, 2H), 6.74 (d, 1H), 6.69-6.62 (m, 3H), 6.50-6.44 (m, 2H), 5.86 (s,1H), 4.72-4.46 (m, 2H), 4.17-4.12 (m, 4H), 3.99-3.94 (m, 2H), 3.56-3.49(m, 2H), 3.15-3.05 (m, 1H), 2.03 (s, 3H); LCMS: 462.1 (M+H)⁺.

Example 43-(3-Hydroxyphenyl)-4-methyl-2-(4-(2-(3-methylazetidin-1-yl)ethoxy)phenyl)-2H-chromen-6-ol

Step 1:3-(3-Hydroxyphenyl)-4-methyl-2-(4-(2-(3-methylazetidin-1-yl)ethoxy)phenyl)-2H-chromen-6-ol

A mixture of from2-(4-iodophenyl)-4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromene(620 mg, 1.0 mmol, Intermediate 3), 2-(3-methylazetidin-1-yl)ethanol(0.17 g, 1.5 mmol, Intermediate 7), CuI (38 mg, 0.2 mmol), K₂CO₃ (280mg, 2.0 mmol), and butyronitrile (2 mL) was degassed with threevacuum/N₂ cycles and then heated at 130° C. for 2 days. After cooling,the reaction mixture was diluted with ethyl acetate and filtered throughCelite. The filtrate was diluted with water and extracted with ethylacetate. The organic layer was washed with water, brine and dried oversodium sulfate, and filtered. The filtrate was concentrated to give thecrude3-methyl-1-(2-(4-(4-methyl-6-((tetrahydro-2H-pyran-2-yl)oxy)-3-(3-((tetrahydro-2H-pyran-2-yl)oxy)phenyl)-2H-chromen-2-yl)phenoxy)ethyl)azetidineas thick gum. This crude material was suspended in 80% acetic acid inwater (10 mL) and stirred at room temperature for 16 h. Excess solventwas removed on a rotary evaporator to give a residue that wasredissolved in ethyl acetate, washed with water, sat'd sodiumbicarbonate, brine and dried over sodium sulfate, filtered andconcentrated. The crude material was purified on silica gel eluted with0-10% methanol in dichloromethane to afford3-(3-hydroxyphenyl)-4-methyl-2-(4-(2-(3-methylazetidin-1-yl)ethoxy)phenyl)-2H-chromen-6-ol:¹H NMR (400 MHz, DMSO-d₆) δ: 9.43 (s, 1H), 8.94 (s, 1H), 7.18 (m, 2H),7.12 (t, 1H), 6.80-6.73 (m, 3H), 6.69-6.60 (m, 3H), 6.52-6.45 (m, 2H),5.76 (s, 1H), 3.81 (t, 2H), 3.37 (t, 2H), 2.72 (t, 2H), 2.66 (t, 2H),2.44-2.36 (m, 1H), 2.02 (s, 3H), 1.06 (d, 3H); LCMS: 444.0 [M+H]⁺.

Example 5(S)-3-(3-Hydroxyphenyl)-4-methyl-2-(4-(2-(3-methylazetidin-1-yl)ethoxy)phenyl)-2H-chromen-6-ol

Separation of the enantiomers from the racemic mixture of Example 4provides the title compound. Suitable separation techniques includechiral chromatography (e.g. RegisCell column [CO₂/methanolw/diethylamine] or CHIRALPAK IA column [hexane/ethanol/tetrahydrofuranw/diethylamine]).

Example 6(R)-3-(3-Hydroxyphenyl)-4-methyl-2-(4-(2-(3-methylazetidin-1-yl)ethoxy)phenyl)-2H-chromen-6-ol

Separation of the enantiomers from the racemic mixture of Example 4provides the title compound. Suitable separation techniques includechiral chromatography (e.g. RegisCell column [CO₂/methanolw/diethylamine] or CHIRALPAK IA column [hexane/ethanol/tetrahydrofuranw/diethylamine])

Example 7: 3×ERE MCF-7 Reporter Assay

MCF7 cells were maintained in RPMI 1640 supplemented with 10% FCS.Transcriptional assays were performed by seeding 100 μL of cells at adensity of 250,000 cells/mL into 96-well cell culture plates in RPMI1640 supplemented with 10% charcoal stripped serum and allowed to attachovernight. Cells were transiently transfected using Lipofectin (LifeTechnologies) according to the manufacturer's protocol. Triplicatetransfections were performed using 300 ng 3×ERE-TK-Luc (reportervector), 50 ng CMVpRL (normalization vector), and 130 ng pCMX (fillerDNA). Transfected cells were incubated overnight then treated withligand. For ER agonist assays, the compounds were serially diluted and50 μL of compound plus RPMI 1640 supplemented with charcoal strippedserum was added to the cells. For ER antagonist assays, the compoundswere serially diluted and 50 μL of compound with RPMI plus 17β-estradiolsupplemented with charcoal stripped serum were added to the cells. Thefinal 17β-estradiol concentration used in the antagonist assays was 0.1nM. Following 24 hour incubation the medium was removed and the cellswere lysed in 40 μL of lysis buffer (25 mM Tris Phosphate, 2 mM CDTA,10% Glycerol, 0.5% Triton X-100, 2 mM DTT). Firefly luciferase activitywas measured immediately following the addition of 40 μL luciferasebuffer (20 mM tricine, 0.1 mM EDTA, 1.07 mM (MgCO₃)₄Mg(OH)₂.5H₂O, 2.67mM MgSO₄, 33.3 mM DTT, 270 μM Coenzyme A, 470 μM luciferin, 530 μM ATP).Renilla luciferase was measured following the addition of 40 μLcolelenterazine buffer (1.1 M NaCl, 2.2 mM Na₂EDTA, 0.22 M KxPO₄ (pH5.1), 0.44 mg/mL BSA, 1.3 mM NaN₃, 1.43 μM coelenterazine, final pHadjusted to 5.0).

Example 8: Breast Cancer Cell Viability Assays

MCF-7 cells were adjusted to a concentration of 40,000 cells per mL inRPMI containing 10% FBS and 20 mM HEPES. 16 microliters of the cellsuspension (640 cells) was added to each well of a 384 well plate, andthe cells were incubated overnight to allow the cells to adhere. Thefollowing day a 10 point, serial 1:5 dilution of each compound was addedto the cells in 16 μL at a final concentration ranging from 10-0.000005μM. After 5 days' compound exposure, 16 μL of CellTiter-GLo (Promega,Madison Wis.) was added to the cells, and the relative luminescenceunits (RLUs) of each well were determined. CellTiter-Glo added to 32 μLof medium without cells was used to obtain a background value. ThePercent viability of each sample was determined as follows: (RLUsample−RLU background/RLU untreated cells−RLU background)×100=%viability.“% Viability relative to Fulvestrant” is calculated as follows:100−{100*[(100−% viability of Example)/(100−% viability ofFulvestrant)]}.

Viability effects in additional ER+ breast cancer cell lines, includingBT474, CAMA1, MDA-MB-361, ZR-75-1, T47D, can be profiled in assayssimilar to Example 8.

Illustrative biological data for representative compounds disclosedherein is presented in the following table:

TABLE 1 MCF7 Viability MCF7 Assay: Viability % Viability Assay: relativeto Example IC₅₀ Fulvestrant 1 0.21 nM 4 2  4.3 nM 4 3 0.07 nM 2 4 0.2 132-(4-(2-(azetidin-1-yl)ethoxy)phenyl)-3-(3- 0.2 25hydroxyphenyl)-4-methyl-2H-chromen-6-ol2-(4-((S)-2-((R)-3-fluoropyrrolidin-1- 0.5 16yl)propoxy)phenyl)-3-(3-hydroxyphenyl)-4- methyl-2H-chromen-6-ol2-(4-((S)-2-(azetidin-1-yl)propoxy)phenyl)- 0.1 303-(3-hydroxyphenyl)-4-methyl-2H- chromen-6-ol(S)-3-(3-Hydroxyphenyl)-4-methyl-2-(4- 0.13 nM 8((S)-2-((R)-3-methylpyrrolidin-1- yl)propoxy)phenyl)-2H-chromen-6-olFulvestrant 0.57 nM 0

Example 9: Breast Cancer Cell ER-α in Cell Western Assay (SP1)

MCF7 cells were trypsinized and washed twice in Phenol Red Free RPMIcontaining 5% Charcoal Dextran Stripped serum with 20 mM HEPES and NEAA,then adjusted to a concentration of 200,000 cells per mL with the samemedium. Next, 16 μL of the cell suspension (3200 cells) was added toeach well of a poly-D-lysine coated 384 well plate, and the cells wereincubated at 37° C. over 4 days to allow the cells to adhere and grow.On day 4, a ten point, serial 1:5 dilution of each compound was added tothe cells in 16 μL at a final concentration ranging from 10⁻⁵M to5.12×10⁻¹²M or 10⁻⁶M to 5.12×10⁻¹³M for fulvestrant. At 4 hours postcompound addition, the cells were fixed by adding 16 μL of 30% formalinto the 32 μL of cells and compound (10% formalin final concentration)for 20 minutes. Cells were then washed twice with PBS Tween 0.1% andthen permeabilized in PBS 0.1% Triton (50 μl/well) for additional 15minutes. The PBS 0.1% triton was decanted, and the cells were washed:LI-COR blocking buffer (50 μL/well) was added, the plate was spun at3000 rpm, and then the blocking buffer was decanted. Additional LI-CORblocking buffer (50 μL/well) was added, and the cells were incubatedovernight at 4° C. The blocking buffer was decanted, and the cells wereincubated overnight at 4° C. with SP1 (Thermo Scientific) anti-ER rabbitmonoclonal antibody diluted 1:1000 in LI-COR blocking buffer/0.1%Tween-20. Wells which were treated with blocking buffer with Tween butno antibody were used as a background control. Wells were washed twicewith PBS Tween 0.1% to remove free SP1 antibodies, and the cells wereincubated at room temp for 60-90 minutes in LI-COR goat anti-rabbitIRDye™ 800CW (1:1000) and DRAQ5 DNA dye (1:10000 of 5 mM stock solution)diluted in LI-COR blocking buffer containing 0.1% Tween-20 and 0.01%SDS. Cells were then washed with 0.1% Tween-20/PBS three times. Plateswere scanned on a LI-COR Odyssey infrared imaging system. Integratedintensities in the 800 nm channel and 700 nm channel were measured todetermine levels of ER-α and DNA respectively. Percent ER levels weredetermined as follows:(Integrated intensity 800 nm sample/integrated intensity 700 nmsample)/(Integrated intensity 800 nm untreated cells/integratedintensity 700 nm untreated cells)×100=% ER-α levels.“% ER-α remaining relative to Fulvestrant” is calculated as follows:100−{100*[(100−% ER level of Example)/(100−% ER level of Fulvestrant)]}.

Effects on steady state levels of ER-α in additional ER+ breast cancercell lines, including BT474, CAMA1, MDA-MB-361, ZR-75-1, T47D, can beprofiled in assays similar to Example 9.

Illustrative biological data for representative compounds disclosedherein is presented in the following table:

TABLE 2 ER-α In-Cell Western ER-α Assay (SP1): In-Cell % ER-α Westernremaining Assay relative to Example (SP1): IC₅₀ Fulvestrant 1 0.20 nM 32  3.4 nM 3 3 0.05 nM 3 4 0.3 142-(4-(2-(azetidin-1-yl)ethoxy)phenyl)-3- 0.3 24(3-hydroxyphenyl)-4-methyl-2H-chromen- 6-ol2-(4-((S)-2-((R)-3-fluoropyrrolidin-1- 0.1 8yl)propoxy)phenyl)-3-(3-hydroxyphenyl)- 4-methyl-2H-chromen-6-ol2-(4-((S)-2-(azetidin-1- 0.1 33 yl)propoxy)phenyl)-3-(3-hydroxyphenyl)-4-methyl-2H-chromen-6-ol (S)-3-(3-Hydroxyphenyl)-4-methyl-2-(4- 0.11 nM9 ((S)-2-((R)-3-methylpyrrolidin-1- yl)propoxy)phenyl)-2H-chromen-6-olFulvestrant 0.39 nM 0

Example 10: Ishikawa Uterine Cell Alkaline Phosphatase Assay

Subconfuent Ishikawa cells in a T225 are incubated 24 hours in anestrogen free basal medium (EFBM) consisting of DMEM:Ham's F-12 50:50phenol red free basal medium containing 5% Charcoal Dextran treated FBSand 20 mM HEPES. Cells are plated the following day in EFBM in clear 384well plates at a concentration of 2.5×105 cells per mL, 16 μL per well(4000 cells per well). A 12 point semilog dilution of each compound iscarried out in DMSO and subsequently diluted in EFBM. An equal volume ofcompound in EFBM is added immediately after plating cells, and the cellsare incubated for 3 days. The cells are fixed with 5% formalin, andrinsed with PBS. Alkaline Phosphatase substrate 4-Nitrophenyl phosphatedisodium salt hexahydrate is added (1 mg/mL final concentration) to asolution containing 2 mM MgCl₂, 1 M diethanolamine, and adjusted to pH9.0. The substrate solution is added to the cell cultures (16 μL perwell), and OD405 is measured in a multiwall plate spectrophotometer whenthe optical density at 405 nm wavelength of cells treated with17β-estradiol in the concentration range of 1-30 nM reaches 1.0-1.2absorbance units. Cells treated with DMSO alone serve as a backgroundcontrol. Percent activity in background subtracted samples is measuredas follows: % activity=OD405 sample/OD405 max of 17β-estradiol treatedcells×100.

Example 11: Ovarian Cancer Cell Viability Assays

BG-1 cells are diluted in RPMI containing 10% FBS and 20 mM HEPES. 16microliters of the cell suspension is added to each well of a 384 wellplate, and the cells are incubated overnight. The following day aneleven point, serial semilog dilution of each compound is added to thecells in 16 μL at a final concentration ranging from 0.3-0.000003 μM.After 5 to 7 days' compound exposure, 16 μL of CellTiter-GLo (Promega,Madison Wis.) is added to the cells, and the relative luminescence units(RLUs) of each well is determined. CellTiter-Glo added to 32 μL ofmedium without cells is used to obtain a background value. The Percentviability of each sample is determined as follows: (RLU sample−RLUbackground/RLU untreated cells−RLU background)×100=% viability.

Viability effects in additional ER+ ovarian cancer cell lines, includingOVKATE, OVSAHO, A1847, SKOV3, SW626, A2780, can be profiled in assayssimilar to Example 11.

Example 12: Ovarian Cancer Cell ER-α in Cell Western Assay

BG-1 cells are diluted in RPMI containing 10% charcoal-stripped FBS and20 mM HEPES. 16 microliters of the cell suspension is added to each wellof a poly-D-lysine 384 well plate, and the cells are incubatedovernight. The following day an eleven point, serial semilog dilution ofeach compound is added to the cells in 16 μL at a final concentrationranging from 0.3-0.000003 μM. At 4 or 24 hr post compound addition, thecells are fixed (10% formalin in PBS) for 20 minutes. Following fixationthe cells are permeablized in PBS 0.1% Triton and blocked with LICORblocking buffer (50 μl/well, 90′). The wells are then incubatedovernight at 4° C. with SP1 rabbit monoclonal Ab (Thermo Scientific)diluted 1:1000 in LICOR blocking buffer/0.1% Tween-20. Wells treatedwith blocking buffer with Tween but no antibody are used as a backgroundcontrol. All wells are washed with 0.1% Tween-20/PBS and then incubatedin goat anti-mouse IRDye™ 800CW (LICOR Inc.; 1:10000) and DRAQ5 DNA dye(1:2000 for 2 mM stock) diluted in LICOR blocking buffer containing 0.1%Tween-20 and 0.01% SDS for 60 minutes. Cells are then washed (50μl/well, 5′ each) in 0.1% Tween-20/PBS. Plates are scanned on a LICOROdyssey infrared imaging system. Integrated intensities in the 800 nmchannel and 700 nm channel are measured to determine levels of ER andDNA respectively. Percent ER levels are determined as follows:(Integrated intensity 800 nm sample/integrated intensity 700 nmsample)/(Integrated intensity 800 nm untreated cells/integratedintensity 700 nm untreated cells)×100=% ER levels.

Effects on steady state levels of ER-α in additional ER+ ovarian cancercell lines, including A1847, SKOV3, SW626, A2780, can be profiled inassays similar to Example 12.

Other cancer cell lines contemplated for testing compounds describedherein include: ER-positive endometrial cell lines (Ishikawa, ECC1,HEC-1, EnCa-101) and ER-positive cervical cell lines (Caski, HeLa,SiHa).

Example 13: PEO Cell Viability Assays

PEO-1, PEO-4 and PEO-6 ovarian cancer cell lines were adjusted to aconcentration of 20,000 cells per mL in RPMI containing 10% FBS. 16microliters of the cell suspension (320 cells) was added to each well ofa 384 well plate, and the cells were incubated overnight to allow thecells to adhere. The following day a 10 point, serial 1:5 dilution ofeach compound was added to the cells in 16 μL at a final concentrationranging from 1-0.0000005 μM. After 7 days' compound exposure, 16 μL ofCellTiter-GLo (Promega, Madison Wis.) was added to the cells the therelative luminescence units (RLUs) of each well was determined.CellTiter-Glo added to 32 μL of medium without cells was used to obtaina background value. The Percent viability of each sample was determinedas follows: (RLU sample−RLU background/RLU untreated cells−RLUbackground)×100=% viability.

Example 14: PEO ER Western Analysis

Cells were plated in RPMI 5% CSS for 48 hours, then treated withcompound for 4 or 24 hours. Cells were lysed in modifiedradioimmunoprecipitation buffer (mRIPA; 10 mM Tris, 150 mM NaCl, 1%(v/v) NP-40, 0.5% deoxycholate, 0.1% SDS, 5 mM EDTA, pH 7.4) containingHalt Protease & Phosphatase Single-Use Inhibitor Cocktail (ThermoScientific, Cat. No. 78442). Total protein of the clarified lysates wasquantitated by Lowry Assay (Biorad DC protein assay). NuPAGE® LDS SampleBuffer and Sample Reducing Agent were added to the lysates and heated to70° C. for 10 mins. 15 ug of total cell protein was separatedelectrophoretically in a NuPAGE 4-12% Bis Tris Gel in MOPS SDS runningbuffer, then transferred to a nitrocellulose membrane in transfer bufferusing an XCell II blot module. Membranes were incubated in BlockingBuffer (LI-COR, Lincoln, Nebr.) for 30 minutes at room temperature,followed by 60 minute incubations with a rabbit antibody against ERalpha (SP-1, Thermo Fisher Scientific, Cat. No. RM-9101), ER beta (CellSignaling Technology, Cat. No. 5513), or mouse antibody against alphatubulin (Sigma, Cat. No. T6199). Following incubation with an IRDye®Conjugated Goat Anti Mouse or Anti Rabbit IgG (LI-COR), protein bandswere quantified using an Odyssey® Infrared Imaging System. Graphing ofdata to determine ER levels was performed using Graphpad PRISM®software. % ER levels were calculated as follows:% ER=(fluorescence ER band of sample−bkgrd/fluorescence Tubulin band ofsample−bkgrd)/(fluorescence ER band of untreatedcells−bkgrd/fluorescence Tubulin of untreated cells−bkgrd)

Example 15: Breast Cancer Model: Xenograft Assay (MCF-7)

Time release pellets containing 0.72 mg 17-β Estradiol weresubcutaneously implanted into nu/nu mice. MCF-7 cells were grown in RPMIcontaining 10% FBS at 5% CO₂, 37° C. Cells were spun down andre-suspended in 50% RPMI (serum free) and 50% Matrigel at 1×10⁷cells/mL. MCF-7 cells were subcutaneously injected (100 μL/animal) onthe right flank 2-3 days post pellet implantation. Tumor volume(length×width²/2) was monitored bi-weekly. When tumors reached anaverage volume of ˜200 mm³ animals were randomized and treatment wasstarted. Animals were treated with Vehicle or Compound daily for 4weeks. Tumor volume and body weight were monitored bi-weekly throughoutthe study. At the conclusion of the treatment period, plasma and tumorsamples were taken for pharmacokinetic and pharmacodynamic analyses,respectively.

Example 16: Breast Cancer Model: Xenograft Assay (MCF-7 Derivative)

Female nu/nu mice (with supplemental 17-β Estradiol pellets; 0.72 mg; 60day slow release) bearing MCF-7 tumors (mean tumor volume 200 mm³) weretreated with Tamoxifen (citrate) by oral gavage. Tumor volume(length×width²/2) and body weight were monitored twice weekly. Followinga significant anti-tumor response in which tumor volume remained static,evident tumor growth was first observed at approximately 100 days oftreatment. At 120 days of treatment, tamoxifen dose was increased.Rapidly growing tumors were deemed tamoxifen resistant and selected forin vivo passage into new host animals. Tumor Fragments (˜100 mm³/animal)from the tamoxifen resistant tumors were subcutaneously implanted intothe right flank of female nu/nu mice (with 17-β Estradiol pellets (0.72mg; 60 day slow release)). Passaged tumors were maintained underconstant Tamoxifen selection, and Tumor volume (length×width²/2) wasmonitored weekly. When tumor volume reached ˜150-250 mm³, animals wererandomized into treatment groups (mean tumor volume 200 mm³) andtamoxifen treatment was terminated (except for a tamoxifen control arm).Animals were treated with Vehicle or Compound daily for 4 weeks. Tumorvolume and body weight were monitored twice weekly for the duration ofthe study. At the conclusion of the treatment period; plasma and tumorsamples were taken for pharmacokinetic and pharmacodynamic analyses,respectively.

TABLE 3 Number of Tumors Smaller at t = 27 days than at Start of study(t = 0 days) 10 30 100 Example Vehicle mpk* mpk* mpk* 3 0/8 0/5 2/8 5/8(S)-3-(3-Hydroxyphenyl)-4-methyl-2-(4- 0/8 0/8 1/8 1/8((S)-2-((R)-3-methylpyrrolidin-1- yl)propoxy)phenyl)-2H-chromen-6-ol*Oral dose administered to animals each day

Example 17: Ovarian Cancer Model: Xenograft Assay (BG-1)

Time release pellets (0.72 mg 17-0 Estradiol/60 days) are subcutaneouslyimplanted into female nu/nu mice. BG-1 cells are grown in DMEM Ham'sF-12 50/50 containing 10% FBS, 10 mM Sodium Pyruvate, 10 mMNon-Essential Amino Acids at 5% CO₂, 37° C. Prior to injection, cellsare trypsinized and suspended in 50% DMEM Ham's F-12 (serum free) and50% Matrigel at 5×10⁷ cells/mL. BG-1 cells are subcutaneously injected(100 μL/animal) on the right flank 2-3 days post pellet implantation.Tumor volume (length×width²/2) is monitored bi-weekly. When tumors reachan average volume of ˜250 mm³ animals are randomized and treatmentstarted. Animals are treated with Vehicle or Compound daily. Tumorvolume and body weight are monitored bi-weekly throughout the study. Atthe conclusion of the treatment period; plasma and tumor samples aretaken for pharmacokinetic and pharmacodynamic analyses, respectively.

Example 18: Endometrial Cancer Model: Xenograft Assay (ECC-1)

ECC-1 cells were grown in DMEM (phenol red, 4.5 g/L glucose andL-glutamine) containing 10% FBS, 1% Non-Essential Amino Acids and 100units Penicillin/Streptomycin at 10% CO₂, 37° C. Cells were spun downand re-suspended in 50% DMEM (serum free) and 50% Matrigel (BD, highconcentration) at 5×10⁷ cells/mL. Time release pellets (0.72 mg 17-βEstradiol/60 days) were subcutaneously implanted into female nu/nu mice.ECC-1 cells were subcutaneously injected (100 μL/animal) on the rightflank 2-3 days post pellet implantation. Tumor volume was monitored andwhen tumors reached a suitable size for transplant they were excised.Excised tumors were cut into small pieces (˜100 mm³) and seriallytransplanted (10 G trocar, right flank) into female nu/nu containingestradiol pellets (0.72 mg 17-β Estradiol/60 days) for 2-3 days. Tumorvolume (length×width×width/2) was monitored and when palpable tumorswere observed, animals were randomized and treatment was started.Animals were treated with Vehicle or Compound daily for 4 weeks or untiltumor volume reached 2000 mm³ (whichever came first). Tumor volume andbody weight were monitored bi-weekly throughout the study. At theconclusion of the treatment period; plasma and tumor samples were takenfor pharmacokinetic and pharmacodynamic analyses, respectively.

Example 19: Immature Uterine Wet Weight-Antagonist Mode

Female immature CD-IGS rats (21 days old upon arrival) were treated forthree days. Animals were dosed daily for three days. Vehicle or testcompound was administered orally by gavage followed 15 minutes later byan oral dose of 0.1 mg/kg Ethynyl Estradiol. On the fourth day 24 hoursafter dose, plasma was collected for pharmacokinetic analysis.Immediately following plasma collection, the animals were euthanized andthe uterus was removed and weighed.

Example 20: Immature Uterine Wet Weight-Agonist Mode

Female immature CD-IGS rats (21 days old upon arrival) were treated forthree days. Animals were dosed daily for three days. Vehicle or testcompound was administered orally by gavage. On the fourth day 24 hoursafter dose, plasma was collected for pharmacokinetic analysis.Immediately following plasma collection, the animals were euthanized andthe uterus was removed and weighed.

Example 21: Adult Uterine Wet Weight-10 Day

Female CD-IGS rats (69 days old, Charles River Laboratories) werepurchased and split into groups. Group 1 was ovariectomized at thevendor (Charles River Laboratories) at 60 days of age and the study wasstarted 2 weeks after surgery, while groups 2-8 were intact. Vehicle ortest compound was administered orally for 10 days. Two hours after the10^(th) and final dose, cardiac punctures were performed and serum wascollected for pharmacokinetic and estradiol analyses. Immediatelyfollowing serum collection, the animals were euthanized and the uterusand ovaries were removed and weighed. Uteri and ovaries from 2 animalsper group were fixed in 10% neutral buffered formalin and sent out to beparaffin embedded, sectioned and stained for H&E (SDPath). Stainedtissues were analyzed in house and then sent out to be read by a boardcertified pathologist. Uteri and ovaries from 4 animals per group wereflash frozen in liquid N₂ for transcriptional analysis, examining aselect set of genes modulated by the estrogen receptor.

Example 22: Breast Cancer Clinical Trial

Purpose:

The purposes of this study are to assess the efficacy of a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, as first- or second-line treatment of estrogen receptor (ER)positive metastatic breast cancer, collect information on any sideeffects the compound may cause, and evaluate the pharmacokineticproperties of the compound.

Intervention:

Patients are administered 1-50 mg/kg of a compound of Formula (I), (II),or (III), or a pharmaceutically acceptable salt thereof, per day ortwice a day.

Outcome Measures:

Primary Outcome Measures: tumor response and/or disease control.

Secondary Outcome Measures: (a) side-effects; (b) pharmacokineticproperties; (c) proportion of patients that have complete or partialresponse or stable disease at defined time points; (d) time toprogression and overall survival; and (e) biomarkers predictive ofclinical response.

Detailed Description:

Patients will be given a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, orally once or twice a day.Prior to each dosing cycle, a physical exam, blood work and assessmentof any side effects will be performed. Every 12 weeks the patient'scancer will be re-evaluated with either a CT scan or MRI to determinewhether the treatment is working. Participation in this study will lastuntil disease progression or unacceptable toxicity.

Eligibility:

Female subjects that are 18 years and older.

Inclusion Criteria:

Histologically or cytologically confirmed diagnosis of invasive breastcancer, stage IV disease; at least one measurable target lesion asdefined by RECIST that has not been previously treated with localtherapy; post-menopausal status; ER positive breast cancer;HER2-negative breast cancer; up to one prior hormonal therapy foradvanced or metastatic disease; ECOG performance status 0-1; lifeexpectancy >12 weeks; adequate liver and bone marrow function: AST<2.5×ULN; Bilirubin <1.5×ULN; ANC >1,500/ul; platelet count >100,000/ul;normal PT and PTT; at least 2 weeks since prior radiation and recoveredfrom treatment-related toxicity.

Exclusion Criteria:

HER2-positive breast cancer; prior chemotherapy regimen for metastaticdisease; history of, or presence of brain metastases; concurrentinvestigational drug treatment; prior bone marrow or stem celltransplant; history of other malignancy within the last 5 years, notincluding curatively-treated carcinoma in situ of the cervix ornon-melanoma skin cancer; uncontrolled infection; active bleeding, orhistory of bleeding requiring transfusion; active cardiac disease;serious medical or psychiatric illness.

Example 23: Endometrial Carcinoma Clinical Trial

Purpose:

The purposes of this study are to assess the efficacy of a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, in the treatment of advanced or metastatic endometrialcarcinoma, collect information on any side effects the compound maycause, and evaluate the pharmacokinetic properties of the compound.

Intervention:

Patients are administered 1-50 mg/kg of a compound of Formula (I), (II),or (III), or a pharmaceutically acceptable salt thereof, per day ortwice a day.

Outcome Measures:

Primary Outcome Measures: tumor response and/or disease control.

Secondary Outcome Measures: (a) side-effects; (b) pharmacokineticproperties; (c) proportion of patients that have complete or partialresponse or stable disease at defined time points; (d) time toprogression and overall survival; and (e) biomarkers predictive ofclinical response.

Detailed Description:

Patients will be given a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, orally once or twice a day.Prior to each dosing cycle, a physical exam, blood work and assessmentof any side effects will be performed. Every 12 weeks the patient'scancer will be re-evaluated with either a CT scan or MRI to determinewhether the treatment is working. Participation in this study will lastuntil disease progression or unacceptable toxicity.

Eligibility:

Female subjects that are 18 years and older.

Inclusion Criteria:

Histologically or cytologically confirmed diagnosis of advanced ormetastatic endometrial carcinoma; at least one measurable target lesionas defined by RECIST that has not been previously treated with localtherapy; hormone receptor positive endometrial carcinoma; ECOGperformance status 0-1; life expectancy >12 weeks; adequate liver andbone marrow function: AST <2.5×ULN; Bilirubin <1.5×ULN; ANC >1,500/ul;platelet count >100,000/ul; normal PT and PTT; at least 2 weeks sinceprior radiation and recovered from prior surgery or treatment-relatedtoxicity.

Exclusion Criteria:

History of, or presence of brain metastases; concurrent investigationaldrug treatment; prior bone marrow or stem cell transplant; history ofother malignancy within the last 5 years, not includingcuratively-treated carcinoma in situ of the cervix or non-melanoma skincancer; uncontrolled infection; active bleeding, or history of bleedingrequiring transfusion; active cardiac disease; serious medical orpsychiatric illness.

Example 24: Ovarian Cancer Clinical Trial

Purpose:

The purposes of this study are to assess the efficacy of a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, in the treatment of advanced ovarian cancer, collectinformation on any side effects the compound may cause, and evaluate thepharmacokinetic properties of the compound.

Intervention:

Patients are administered 1-50 mg/kg of a compound of Formula (I), (II),or (III), or a pharmaceutically acceptable salt thereof, per day ortwice a day.

Outcome Measures:

Primary Outcome Measures: tumor response and/or disease control

Secondary Outcome Measures: (a) side-effects; (b) pharmacokineticproperties; (c) proportion of patients that have complete or partialresponse or stable disease at defined time points; (d) time toprogression and overall survival; and (e) biomarkers predictive ofclinical response.

Detailed Description:

Patients will be given a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, orally once or twice a day.Prior to each dosing cycle, a physical exam, blood work (including tumormarkers, e.g., CA-125) and assessment of any side effects will beperformed. Every 12 weeks the patient's cancer will be re-evaluated witheither a CT scan or MRI to determine whether the treatment is working.Participation in this study will last until disease progression orunacceptable toxicity.

Eligibility:

Female subjects that are 18 years and older.

Inclusion Criteria:

Histologically or cytologically confirmed diagnosis of advanced ovariancancer; at least one measurable target lesion as defined by RECIST thathas not been previously treated with local therapy; ER positive ovariancancer; ECOG performance status 0-1; life expectancy >12 weeks; adequateliver and bone marrow function: AST <2.5×ULN; Bilirubin <1.5×ULN;ANC >1,500/ul; platelet count >100,000/ul; normal PT and PTT; at least 2weeks since prior radiation and recovered from prior surgery ortreatment-related toxicity.

Exclusion Criteria:

History of, or presence of brain metastases; concurrent investigationaldrug treatment; prior bone marrow or stem cell transplant; history ofother malignancy within the last 5 years, not includingcuratively-treated carcinoma in situ of the cervix or non-melanoma skincancer; uncontrolled infection; active bleeding, or history of bleedingrequiring transfusion; active cardiac disease; serious medical orpsychiatric illness.

Example 25: ER-Positive NSCLC Clinical Trial

Purpose:

The purposes of this study are to assess the efficacy of a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, as single agent or in combination in the treatment of advancedor metastatic estrogen receptor (ER) positive non-small cell lung cancer(NSCLC), collect information on any side effects the compound may causeas single agent or in combination, and evaluate the pharmacokineticproperties of the compound as single agent or in combination.

Intervention:

Patients are administered 1-50 mg/kg of a compound of Formula (I), (II),or (III), or a pharmaceutically acceptable salt thereof, per day ortwice a day as single agent or in combination.

Outcome Measures:

Primary Outcome Measures: tumor response and/or disease control.Secondary Outcome Measures: (a) side-effects; (b) pharmacokineticproperties; (c) proportion of patients that have complete or partialresponse or stable disease at defined time points; (d) time toprogression and overall survival; and (e) biomarkers predictive ofclinical response.

Detailed Description:

Patients will be given a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, orally once or twice a day assingle agent or in combination. Prior to each dosing cycle, a physicalexam, blood work and assessment of any side effects will be performed.Every 12 weeks the patient's cancer will be re-evaluated with either aCT scan or MRI to determine whether the treatment is working.Participation in this study will last until disease progression orunacceptable toxicity.

Eligibility:

Male and female subjects that are 18 years and older.

Inclusion Criteria:

Histologically or cytologically confirmed diagnosis of advanced ormetastatic ER-positive NSCLC; at least one measurable target lesion asdefined by RECIST that has not been previously treated with localtherapy; ECOG performance status 0-1; life expectancy >12 weeks;adequate liver and bone marrow function: AST <2.5×ULN; Bilirubin<1.5×ULN; ANC >1,500/ul; platelet count >100,000/ul; normal PT and PTT;at least 2 weeks since prior radiation and recovered from prior surgeryor treatment-related toxicity.

Exclusion Criteria:

History of, or presence of brain metastases; concurrent investigationaldrug treatment; prior bone marrow or stem cell transplant; history ofother malignancy within the last 5 years, not includingcuratively-treated carcinoma in situ of the cervix or non-melanoma skincancer; uncontrolled infection; active bleeding, or history of bleedingrequiring transfusion; active cardiac disease; serious medical orpsychiatric illness.

Example 26: Endometriosis Clinical Trial

Purpose:

The purposes of this study are to assess the efficacy of a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, as single agent or in combination in the treatment of patientswith symptomatic/severe endometriosis, collect information on any sideeffects the compound may cause as single agent or in combination, andevaluate the pharmacokinetic properties of the compound as single agentor in combination.

Intervention:

Patients are administered 1-50 mg/kg of a compound of Formula (I), (II),or (III), or a pharmaceutically acceptable salt thereof, per day ortwice a day as single agent or in combination.

Outcome Measures:

The outcome measures of this study are symptoms improvement and/or painrelief and shrinkage of endometrial tissue.

Detailed Description:

Patients will be given a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, orally once or twice a day assingle agent or in combination. Prior to each dosing cycle, a physicalexam, blood work and assessment of any side effects will be performed.

Eligibility:

Female subjects that are 18 years and older.

Inclusion Criteria:

Diagnosis of symptomatic endometriosis; pre- or peri-menopausal status;ECOG performance status 0-1; adequate liver and bone marrow function:AST <2.5×ULN; Bilirubin <1.5×ULN; ANC >1,500/ul; plateletcount >100,000/ul; normal PT and PTT; at least 2 weeks since priorsurgery or treatment-related toxicity.

Exclusion Criteria:

Pregnancy or lactating; history of other malignancy within the last 5years, not including curatively-treated carcinoma in situ of the cervixor non-melanoma skin cancer; concurrent investigational drug treatment;uncontrolled infection; active cardiac disease; serious medical orpsychiatric illness.

Example 27: Uterine Leiomyoma Clinical Trial

Purpose:

The purposes of this study are to assess the efficacy of a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, as single agent or in combination in the treatment of patientswith symptomatic uterine leiomyoma, collect information on any sideeffects the compound may cause as single agent or in combination, andevaluate the pharmacokinetic properties of the compound as single agentor in combination.

Intervention:

Patients are administered 1-50 mg/kg of a compound of Formula (I), (II),or (III), or a pharmaceutically acceptable salt thereof, per day ortwice a day as single agent or in combination.

Outcome Measures:

The outcome measures of this study are symptoms improvement and/or painrelief and shrinkage of leiomyomas.

Detailed Description:

Patients will be given a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, orally once or twice a day assingle agent or in combination. Prior to each dosing cycle, a physicalexam, blood work and assessment of any side effects will be performed.

Eligibility:

Female subjects that are 18 years and older.

Inclusion Criteria:

Diagnosis of symptomatic uterine leiomyoma; pre- or peri-menopausalstatus; ECOG performance status 0-1; adequate liver and bone marrowfunction: AST <2.5×ULN; Bilirubin <1.5×ULN; ANC >1,500/ul; plateletcount >100,000/ul; normal PT and PTT; at least 2 weeks since priorsurgery or treatment-related toxicity.

Exclusion Criteria:

Pregnancy or lactating; history of other malignancy within the last 5years, not including curatively-treated carcinoma in situ of the cervixor non-melanoma skin cancer; concurrent investigational drug treatment;uncontrolled infection; active cardiac disease; serious medical orpsychiatric illness.

Example 28: Parenteral Pharmaceutical Composition

To prepare a parenteral pharmaceutical composition suitable foradministration by injection (subcutaneous, intravenous), 100 mg of awater-soluble compound of Formula (I), (II), or (III), orpharmaceutically acceptable salt thereof, is dissolved in sterile waterand then mixed with 10 mL of 0.9% sterile saline. The mixture isincorporated into a dosage unit form suitable for administration byinjection

In another embodiment, the following ingredients are mixed to form aninjectable formulation: 1.2 g of a compound of Formula (I), (II), or(III), or a pharmaceutically acceptable salt thereof, 2.0 mL of sodiumacetate buffer solution (0.4 M), HCl (1 N) or NaOH (1 M) (q.s. tosuitable pH), water (distilled, sterile) (q.s. to 20 mL). All of theabove ingredients, except water, are combined and stirred and ifnecessary, with slight heating if necessary. A sufficient quantity ofwater is then added.

Example 29: Oral Solution

To prepare a pharmaceutical composition for oral delivery, an aqueous20% propylene glycol solution is prepared. To this is added a sufficientamount of a compound of Formula (I), (II), or (III), or apharmaceutically acceptable salt thereof, to provide a 20 mg/mLsolution.

Example 30: Oral Capsule

To prepare a pharmaceutical composition for oral delivery, 10-1500 mg ofa compound of Formula (I), (II), or (III), or a pharmaceuticallyacceptable salt thereof, is mixed with starch. The mixture isincorporated into an oral dosage unit such as a hard gelatin capsule,which is suitable for oral administration.

In another embodiment, 10-1500 mg of a compound of Formula (I), (II), or(III), or a pharmaceutically acceptable salt thereof, is placed intoSize 4 capsule, or size 1 capsule (hypromellose or hard gelatin) and thecapsule is closed.

Example 31: Oral Tablet

A tablet is prepared by mixing 48% by weigh of a compound of Formula(I), (II), or (III), or a pharmaceutically acceptable salt thereof, 45%by weight of microcrystalline cellulose, 5% by weight of low-substitutedhydroxypropyl cellulose, and 2% by weight of magnesium stearate. Tabletsare prepared by direct compression. The total weight of the compressedtablets is maintained at 250-500 mg.

Example 32: Topical Gel Composition

To prepare a pharmaceutical topical gel composition, a compound ofFormula (I), (II), or (III), or a pharmaceutically acceptable saltthereof, is mixed with hydroxypropyl celluose, propylene glycol,isopropyl myristate and purified alcohol USP. The resulting gel mixtureis then incorporated into containers, such as tubes, which are suitablefor topical administration.

The examples and embodiments described herein are for illustrativepurposes only and various modifications or changes suggested to personsskilled in the art are to be included within the spirit and purview ofthis application and scope of the appended claims.

What is claimed is:
 1. A pharmaceutical composition consisting of acompound that has the following structure of Formula (III):

or a pharmaceutically acceptable salt thereof; and one or morepharmaceutical excipients selected from the group consisting ofmicrocrystalline cellulose, low-substituted hydroxypropyl cellulose,starch, and magnesium stearate.
 2. The pharmaceutical composition ofclaim 1, wherein the compound is a hydrochloride salt.